Analgesic effect of butorphanol in ponies following castration.

REASONS FOR PERFORMING STUDY: In the UK butorphanol has a marketing authorisation for administration to horses for sedation in combination with detomidine, and at a higher dose (0.1 mg/kg bwt), for the alleviation of pain. There is only a limited number of clinical studies designed to examine the analgesic effects of butorphanol administration following surgery. OBJECTIVE: To investigate the effect of premedication with butorphanol on post operative pain following castration under general anaesthesia in ponies. HYPOTHESIS: Ponies receiving butorphanol would experience less pain after castration than ponies that did not receive butorphanol. METHODS: A randomised, observer blinded clinical study in which 20 ponies received butorphanol and detomidine (Group B) or detomidine alone (Group C). Anaesthesia was induced with ketamine and diazepam and open castration performed. Pain was assessed by one individual using a dynamic interactive visual analogue scale (DIVAS) 100 mm in length (0 = no pain, 100 mm the maximum possible pain for that procedure). 'Rescue' analgesia was administered when DIVAS >50 mm and was butorphanol i.v. On the second occasion DIVAS was >50 mm, flunixin was administered i.v. Data from the DIVAS were analysed using a Mann Whitney Test. RESULTS: Only one animal did not require rescue analgesia after surgery (Group C). DIVAS were not significantly different between groups (P = 0.063). CONCLUSIONS AND POTENTIAL RELEVANCE: Castration is sufficiently painful that administration of a single preoperative dose of butorphanol does not provide adequate post operative analgesia.

Recovery characteristics following maintenance of anaesthesia with sevoflurane or isoflurane in dogs premedicated with acepromazine.

A standard anaesthetic protocol was used to anaesthetise 40 dogs for intravenous urography and a retrograde urethrogram or vaginourethrogram. The dogs were allocated by blocked randomisation to receive either isoflurane or sevoflurane for maintenance of anaesthesia after they had been premedicated with acepromazine and pethidine, and anaesthesia induced with propofol. An observer who was unaware of which agent had been used assessed ataxia 30 and 60 minutes after discontinuation of administration of the anaesthetic and assigned an overall recovery score. No complications occurred during anaesthesia of either group of dogs. The scores for ataxia were significantly lower after 60 minutes than after 30 minutes, but there was no significant difference between the groups. The quality of recovery was significantly better in the dogs that received sevoflurane than in those that received isoflurane, but the recovery times were similar.

A multicentre, prospective, randomised, blinded clinical trial to compare some perioperative effects of buprenorphine or butorphanol premedication before equine elective general anaesthesia and surgery.

REASONS FOR PERFORMING STUDY: Buprenorphine, a µ-agonist opioid, has recently been licensed for equine use, but butorphanol, a κ-agonist opioid, is more commonly used in horses. The effect of the 2 opioids has not previously been compared in a large clinical study. OBJECTIVES: To compare post operative analgesia and physiological variables in horses undergoing elective surgery following premedication with either buprenorphine or butorphanol in a conventional clinical setting. STUDY DESIGN: Multicentre, prospective, randomised, blinded clinical investigation. METHODS: Eighty-nine healthy horses admitted for elective surgery to one of 6 UK equine veterinary clinics were premedicated with acepromazine, a nonsteroidal anti-inflammatory drug, and romifidine followed by intravenous (i.v.) buprenorphine or butorphanol. Anaesthesia was induced with diazepam/ketamine and maintained with isoflurane in oxygen. A range of surgical procedures were performed and supplementary anaesthetic agents given as required. Physiological variables were monitored during anaesthesia and pain, ataxia, sedation and vital function were assessed post operatively. Data were analysed using t-tests, ANOVA, Mann-Whitney U-test and Chi-squared test as appropriate and P<0.05 was regarded as significant, except for multiple comparisons, when P<0.01 was used. RESULTS: Surgery was carried out successfully in all cases and no mortality or serious morbidity occurred. Physiological variables remained within normal limits and all horses recovered successfully, most standing within 1 h of ceasing anaesthesia. There were no significant differences between groups in any variable except post operative pain when scores (simple descriptive scale) between 3 and 6 h were significantly lower after buprenorphine than after butorphanol. CONCLUSIONS: Horses experienced less post operative pain after buprenorphine than after butorphanol premedication. Compared with butorphanol, buprenorphine did not cause any different effects on vital function.

Prediabetes and perinatal mortality.

OBJECTIVE: The association between gestational diabetes mellitus (GDM) and perinatal outcome is largely based on case series and retrospective studies that found an increased risk of perinatal mortality and stillbirth as the onset of diabetes approached. Our objective was to assess the relationship between latency to diabetes and perinatal outcome of prediabetic pregnancies in a contemporary population of women with adult-onset diabetes. RESEARCH DESIGN AND METHODS: A population of 403 diabetic women from two recruitment sites completed a pretested questionnaire. RESULTS: Details of 1,181 pregnancy outcomes were obtained. This comprised 1,024 live births, 22 stillbirths, and 8 early neonatal deaths. Crude analysis suggested a relationship between time to diabetes (latency) < or =20 years and both perinatal death and stillbirth: odds ratio (95% CI), 2.41 (1.17-4.95) and 2.15 (0.93-4.98). Generalized additive modeling revealed a nonlinear relationship between the variables time to diabetes, and maternal age and perinatal outcome. Final logistic regression analysis was then performed for the outcomes perinatal death and stillbirth, with maternal age as a second-degree polynomial, year of birth as a continuous variable, and time to diabetes dichotomized < or =20 years to diagnosis and >20 years. This final analysis documented a significant association between time to diabetes < or =20 years and both perinatal death (4.06 [1.79-9.36]) and stillbirth (3.35 [1.25-9.05]). CONCLUSIONS: There appeared to be an increased risk of perinatal death and stillbirth in pregnancies occurring in the last 20 years before the diagnosis of diabetes.

[Predictive equations and analysis of influence factors of lung ventilation based on a large occupational population in North China].

OBJECTIVE: To establish suitable predictive equations of lung function for occupational population in North China. METHODS: A total of 5 002 on the job or retired healthy adults from five enterprises in North China with category of mild or moderate work intensity underwent spirometry using a Chest HI-198 spirometer and the procedures recommended by the American Thoracic Society, were a sample. RESULTS: The data of 3 913 subjects were used. A normal distribution of our data was shown using the normality test and distribution curve. Univariate analysis showed that both age and height were significantly correlated with FVC, FEV(1), FEV(1)/FVC (%) and MMF. Further multiple linear stepwise regression analysis indicated that the levels of FVC, FEV(1), FEV(1)/FVC (%) and MMF were highly influenced by age, height, and weight rather than chest circumference. Thus, only age, height, and weight were introduced into our regression equations. Data from the studied subjects and other source were utilised to examine the validity of the equations and a high accordance rate (> 90%) was obtained. No significant difference (P > 0.05) was found in the predictive values between the simplified equations and equations in which more variables were included. CONCLUSION: The studied predictive equations for male non-smokers, female non-smokers, and male smokers were established based on data from a large occupational population. These equations should be more applicable for evaluating lung ventilatory function of occupational populations in North China.

Parkinson's disease: a test of the multifactorial etiologic hypothesis.

We studied the relative etiologic importance upon the development of Parkinson's disease (PD) of occupational exposure to herbicides and other compounds, ionizing radiation exposure, family history of PD and essential tremor, smoking, and history of various viral and other medical conditions. We identified patients (n = 130) with neurologist-confirmed idiopathic PD through contacts with Calgary general hospitals, long-term care facilities, neurologists, the Movement Disorder Clinic, and the Parkinson's Society of Southern Alberta, and selected two matched (by sex and age +/- 2.5 years) community controls for each case by random digit dialing. We obtained lifetime work, chemical, radiation, medical, and smoking exposure histories and family histories of PD and essential tremor by personal interviews, and analyzed the data using conditional logistic regression for matched sets. After controlling for potential confounding and interaction between the exposure variables, using multivariate statistical methods, having a family history of PD was the strongest predictor of PD risk, followed by head trauma and then occupational herbicide use. Cases and controls did not differ in their previous exposures to smoking or ionizing radiation; family history of essential tremor; work-related contact with aluminum, carbon monoxide, cyanide, manganese, mercury, or mineral oils; or history of arteriosclerosis, chicken pox, encephalitis, hypertension, hypotension, measles, mumps, rubella, or Spanish flu. These results support the hypothesis of a multifactorial etiology for PD, probably involving genetic, environmental, trauma, and possibly other factors.

Parkinson's disease and exposure to agricultural work and pesticide chemicals.

This population-based case-control study of 130 Calgary residents with neurologist-confirmed idiopathic Parkinson's disease (PD) and 260 randomly selected age- and sex-matched community controls attempted to determine whether agricultural work or the occupational use of pesticide chemicals is associated with an increased risk for PD. We obtained by personal interviews lifetime occupational histories, including chemical exposure data, and analyzed the data using conditional logistic regression for matched sets. In the univariate analysis, a history of field crop farming, grain farming, herbicide use, or insecticide use resulted in a significantly increased crude estimate of the PD risk, and the data suggested a dose-response relation between the PD risk and the cumulative lifetime exposure to field crop farming and to grain farming. However, in the multivariate analysis, which controlled for potential confounding or interaction between the exposure variables, previous occupational herbicide use was consistently the only significant predictor of PD risk. These results support the hypothesis that the occupational use of herbicides is associated with an increased risk for PD.

An assessment of the usefulness of demographic data provided by surrogate respondents in a case-control study of Parkinson's disease.

This study, based upon data from 40 non-demented Parkinson's disease cases and 101 community controls, and similar data provided by either the spouse (n = 110) or an adult child (n = 31) of each index subject, attempted to assess the usefulness of various demographic data provided by the surrogate respondents for the index subjects. The data were collected by personal interview using a structured questionnaire specifically developed for this study. Ninety-one percent of the index subjects and their surrogates provided information on the annual family income and 98% provided other demographic information. The analysis was done by three groups: the case-surrogates, the control-surrogates and the combined index subject-surrogates, and within each group by the two types of surrogates for the index subjects: the spouse vs adult child. The overall percent agreement between the index subjects and their surrogates varied from moderate for annual family income (54.1%), to good for educational level (61.6%) and to excellent for ethnic origin (82.6%), for age +/- 1 year (97.9%) and for marital status (100.0%). No significant differences in agreement were found for any of these demographic variables either between the case-surrogate group and the control-surrogate group, or between the spouse surrogates and the child surrogates. These findings suggest that spouses and adult children can provide valid information and are equally reliable informants concerning the demographic characteristics of index subjects in a case-control study of Parkinson's disease and, possibly, of other diseases.

Reliability of environmental and occupational exposure data provided by surrogate respondents in a case-control study of Parkinson's disease.

This study used data provided by 40 non-demented Parkinson's disease patients and 101 community controls, and by their 110 spouses and 31 adult children to assess the reliability of surrogate-provided rural environmental and occupational exposure information on the index subjects. The level of overall raw agreement between the index subjects and the spouse or adult child surrogates varied from 50.0 to 100.0% for the case-surrogate group and from 80.6 to 96.0% for the control-surrogate group. We did not detect significant differences in overall raw agreement between the case-surrogate and control-surrogate groups or between the spouse-surrogate and adult child-surrogate groups, for any of the variables studied. Considering all index subjects and their surrogates, the level of overall raw agreement was 80.3% for well water consumption, 82.3% for farm living, 85.8% for agricultural work, 87.1% for use of pesticides, 87.9% for field crop farming and 91.9% for use of fertilizers. However, the kappa estimates were lower, varying from 0.48 (SE = 0.20) for fertilizer use to 0.66 (SE = 0.11) for crop farming. The level of specific agreement was 52.2% for fertilizer use, 64.0% for pesticide use, 71.4% for agricultural work, 73.9% for crop farming, 80.9% for farm living, and 83.6% for well water consumption. The overall findings of this study support the use, if necessary, of spouses and adult children of index subjects as surrogate respondents in case-control studies of rural environment and occupational exposures and Parkinson's disease and, possibly, other neurologic diseases. Specific agreement seems to be a better index of reliability than overall agreement in studies where exposure is rare.

The epidemiology of premenstrual symptoms in a population-based sample of 2650 urban women: attributable risk and risk factors.

This epidemiologic survey achieved a reliable measure of the prevalence of premenstrual symptoms by avoiding the biases of small or selected samples, anamnestic error, and subjective expectation. From 6232 women (a 78.8% response), aged 20-49 years, identified through a random sample of urban households, the 24-hour prevalence of symptoms was obtained using the Moos' Menstrual Distress Questionnaire, administered without reference to the menstrual cycle. For 71% of the naturally cycling women, current cycle phase was determined by follow-up (n = 2650); but a higher prevalence of severe or moderately severe affective symptoms in the premenstrual compared to the mid-cycle phase was not found. However, observed risk factor interactions led to the conclusion that premenstrual distress is a discrete mood disorder, affecting women aged 25-35 years, with probable ovulatory cycles, and vulnerable to stress; and that the risk of affective symptoms attributable to the premenstrual state was one percent.

Preventive antibiotic usage in traumatic thoracic injuries requiring closed tube thoracostomy.

OBJECTIVE: To evaluate the safety and effectiveness of antibiotics in reducing the infectious complications following closed tube thoracostomy for isolated chest trauma. DESIGN: Double-blind, randomized clinical trial. SETTING: Medical school affiliated large urban teaching hospital and trauma center. PATIENTS: One hundred nineteen of 159 patients over 18 years old presenting to the emergency department requiring closed tube thoracostomy for isolated chest injuries (113 penetrating, 6 blunt). INTERVENTION: Patients received either placebo or 1 g cefonicid daily intravenously started at chest tube insertion and stopped within 24 h of removal. MEASUREMENTS AND RESULTS: The development of wound infections, pneumonia (CDC criteria), or empyema; the incidence of adverse events; length of hospitalization. One nonspecific infection was seen in the cefonicid group (1.6 percent) and six respiratory tract infections (10.7 percent) in the placebo group (three empyema, one empyema with pneumonia, two pneumonia) (p = 0.0505; p = 0.0094 [excluding nonspecific infection]). No significant differences with antibiotic use were seen in the duration of chest tube use (p = 0.766), peak WBC counts (p = 0.108), lower peak temperatures (p = 0.063), or length of hospitalization (p = 0.165). Patients who developed infectious complications averaged approximately 8 days longer hospitalization than those without (p < 0.0001). CONCLUSION: This study showed that patients receiving antibiotics had a significantly reduced rate of infection than did patients administered placebo. No significant adverse events were seen in either group.

Video display terminal use and spontaneous abortion risk.

A matched case-control study investigated the potential effects of video display terminal (VDT) use on risk of spontaneous abortion in pregnancy. Structured interviews were administered to 334 cases immediately following a miscarriage. For each case, two age and parity-matched controls were enrolled, the first being a woman still pregnant (less than 25 weeks' gestation), and the second a woman in the postpartum ward of the same participating hospital. Separate analyses were carried out for each comparison group due to potential and observed differences in recall loss and selection bias. The overall exposure to VDT's during the period of interest (three months preceding the last menstrual period [LMP] to four months post-LMP) did not indicate an increased risk for either control group comparison (OR = 1.14, p = 0.47 with postnatal controls; OR = 0.80, p = 0.20 with prenatal controls). Furthermore, when exposure data were re-classified to remove women with distant or single exposures, no significant odds ratios were found. While several socioeconomic and obstetric variables were significantly associated with VDT use, multivariate analysis did not alter the lack of association of VDT use with case-control status. Finally, evidence for recall bias in postnatal control reporting, evidenced by underreporting of trivial exposures in this group, is examined.

Cardiopulmonary resuscitation performed in patients with terminal illness in Chiang Mai University Hospital, Thailand.

BACKGROUND: The original target of cardiopulmonary resuscitation (CPR) was victims of acute cardiopulmonary arrest. However, the use of CPR has expanded to a wide variety of patients including those with terminal illness for whom CPR is futile. The objective of this study was to identify the incidence of CPR performed, the severity of illness and the outcome of CPR attempted in terminal illness in a teaching hospital. METHODS: Cardiopulmonary resuscitation attempted in terminal illness was retrospectively assessed from the medical records of hospital deaths with any one of eight life-threatening diagnoses during a 3.5-year period. RESULTS: Of 532 hospital deaths from terminal illness, 411 records (77.3%) were reviewed and abstracted. Most of the 411 patients had a low pre-CPR functional status. Generally, CPR was performed in 270 (65.7%) cases; 114 of those given CPR (42.2%) initially survived, but all died shortly after the manoeuvre. The high death rate following CPR may reflect both terminal illnesses and the severity of pre-event functional capacity of patients. CONCLUSION: The criteria for CPR in this group of patients need to be re-assessed and use of a Cerebral Performance Categories (CPC) score may be helpful.

Cancer mortality of Chinese in Canada.

Cancer deaths determined from national vital statistics in Canadian ('Chinese') immigrants who were born in mainland China, Hong Kong or Taiwan were compared with those in the Canadian-born population. Standardized mortality ratios (SMR) based on 1981 census data and on 755 deaths among 81,740 Chinese males and 586 deaths among 83,965 females during 1980-1984, showed that the overall cancer mortality in Chinese males (SMR 141), and females (SMR 116), was significantly higher than in the Canadian-born. Moreover, SMR varied by cancer site and showed a pattern of risks similar to those reported for foreign-born Chinese in the USA: strikingly high SMR for nasopharynx and liver or gallbladder in males and females; high ratios for stomach, intestines or colon, rectum, and lung, but a low ratio for prostate in males; and high ratios for lung and cervix uteri but low ratios for breast and ovary in females. These findings indicate that useful studies on cancer mortality could be carried out in Canadian Chinese.

Childhood and adolescent passive smoking and the risk of female lung cancer.

BACKGROUND: Few studies have reported the relationship between passive smoking (PS) in early life and the risk of lung cancer. This study was done to evaluate the risk of female lung cancer from PS, especially that during childhood and adolescence. METHODS: Using household exposure to tobacco smoke as an estimate of PS, a 1:1 paired case-control study was conducted in Harbin, China. We interviewed 114 female primary lung cancer cases, aged 30-69 years, and their hospital-based controls. The controls were non-cancer patients, selected from the same hospital as the cases, and matched on age (+/- 5 years), residential area and smoking status over their lifetime. There were 59 pairs who ever smoked and 55 pairs who never smoked. Information on PS was collected by residence for each of the following periods: 0-6, 7-14, 15-22, 23-30 and 31-69 years. RESULTS: Household PS significantly increases the risk of female lung cancer for those exposed at ages 22 or younger, who have ever smoked. The risk was also increased for those non-smoking pairs when exposed under the age of 15 years. Exposure to maternal smoking at ages 14 or younger increased the risk by about 170% (odds ratio, OR 2.7, 95% confidence interval [CI]: 1.49-4.88), but not to paternal smoking (OR 1.40, 95%CI: 0.92-2.50). The risk was highest for those exposed under the age of seven (OR 3.46, 95%CI: 1.80-6.65) and was also significant at ages 7-14 (OR 3.08, 95% CI: 1.62-5.57) and 15-22 (OR 3.10, 95%CI: 1.52-6.31) years. Under the age of 23 years, the OR increased with amount of PS (P < 0.001). Of note, the OR in all five exposure periods for non-smoking pairs were similar to those for all 114 pairs studied. CONCLUSIONS: Household PS, particularly that during childhood, increases the risk of female lung cancer. The assessment of PS should be done by different periods of exposure.

Drug-induced depression. Incidence, avoidance and management.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), drug-induced depression may be classified as an Organic Mood Syndrome, Depressed Type. Unfortunately, the DSM-III-R diagnostic criteria are not sufficiently precise for application in research, and studies of drug-induced depression have rarely utilised these criteria. Research concerned with drug-induced depression is characterised by a number of methodological complications. These include differing definitions of depression, including depression defined as a symptom, a syndrome, or by diagnostic criteria for a specific mental disorder. In addition, patients undergoing pharmacological treatments for medical illnesses are typically exposed to considerable psychosocial stress due to the suffering and disability associated with illness. These psychosocial factors may in themselves precipitate episodes of depression. Due to these complicating factors, sophisticated study designs are required to confirm an aetiological role for medications as risk factors for depression. Unfortunately, adequate studies have rarely been conducted, and much of the literature consists of case reports and clinical observations. Consequently, clinicians are frequently required to make clinical judgements about the aetiology of patients' depressive symptoms in the absence of definitive scientific information about the role of drugs. Nevertheless, a knowledge of the relevant literature will assist clinicians in making reasoned judgements about the aetiology, prevention and management of these disorders.

Clinical efficacy and safety of cyproterone acetate in severe hirsutism: results of a multicentered Canadian study.

We compared the efficacy and safety of cyproterone acetate (Shering AC, Berlin, FRG) at a low (Diane, 2 mg) or a high dose (Androcur, 100 mg) in the treatment of 158 patients with severe hirsutism. At baseline, no difference was observed in mean hirsutism total index (19.5 Diane versus 20.1 Androcur) or distribution (facial, bust, or abdomen). By the end of the study, patient loss in Diane and Androcur groups was 29.1% and 27.8%, respectively, and the mean percent difference in the scoring index was as follows: total, 24.6 Diane versus 30.8 Androcur, P less than 0.05; facial, 30.1 Diane versus 33.0 Androcur, P less than 0.10; bust, 12.1 Diane versus 31.2 Androcur, P less than 0.02; and abdomen, 20.1 Diane versus 31.2 Androcur, P less than 0.02. Except for breast tenderness (Diane greater than Androcur), amenorrhea, and weight gain, (Androcur greater than Diane), the incidence of side effects was comparable in both groups.

Association of semen quality and occupational factors: comparison of case-control analysis and analysis of continuous variables.

OBJECTIVE: To compare two statistical approaches, case-control and analysis of continuous parameters of semen, in examining the relationship between occupational exposures and male reproductive function. DESIGN: Case-control study. SETTING: Males providing semen samples at a university infertility clinic. PATIENT(S): Nonvasectomized males who provided at least one semen sample at an infertility clinic. MAIN OUTCOME MEASURE(S): Standard clinical semen analysis. RESULT(S): Analyses using a dichotomous dependent variable did not uncover significant associations between any occupational factor and infertility case status. However, linear models incorporating continuous variables identified a number of occupational factors that were associated with specific parameters of semen. A reduction in percentage of progressive sperm and an increase in percentage of coiled tail sperm defects in welders, compared with unexposed subjects, were found. Significant dose-response relationships between level of perceived job stress and percentage of progressive sperm, total motile count, morphology, abnormal heads, and coiled tail defects were found. CONCLUSION(S): The findings suggest that subtle changes in semen variables, possibly associated with workplace exposure, may be detected only with parametric analyses of continuous variables of semen.

Incidence of hospital-acquired infections associated with caesarean section.

A retrospective cohort study was conducted to determine the incidence of post-caesarean infections in a Canadian community teaching hospital using computer algorithms designed for the diagnosis of nosocomial infections. Inferential chart review was done on 1335 women delivered by lower-segment caesarean section (793 primary and 542 secondary) at the Calgary General Hospital between January 1985 and April 1988. The overall infection rates were 42.1 and 46.1% for women delivered by primary and secondary caesarean section, respectively. Incisional surgical wound infection accounted for the largest proportion of post-caesarean infections found. Women delivered by primary caesarean section had significantly higher rates of endometritis, deep surgical wound infection and bacteraemia than those delivered by secondary section. All types of post-caesarean infection, except asymptomatic bacteriuria, caused the duration of the post-partum hospital stay to be significantly increased.

Athletic injury reporting. Development of universal systems.

There are numerous athletic injury reporting systems currently in place. In order for our understanding of athletic injury epidemiology to advance, we must be able to compare data from divergent sources. This paper provides a review of existing athletic injury reporting systems in North America. The epidemiological designs employed in these systems are outlined, along with a description of the strengths and weaknesses of each approach to reporting. The differences between the case-series and cohort methods are delineated and the importance of injury definition, sources of error, denominator data and exposure estimation are discussed within this context. Four recommendations are then offered to assist in moving toward more universal systems for athletic injury reporting. First, comparability of data between systems should be maximised through clear indication of the reporting system design and the methods of data collection. Secondly, an exact definition should be given as to what constitutes a reportable event ('injury'). Thirdly, whenever possible, outcome information should be collected on each reported event so that an injury definition may be applied at the time of data analysis. Lastly, any limitations or sources of error should be acknowledged.