Elective cricothyrotomy in a dog with transient laryngeal paralysis secondary to Australian paralysis tick (Ixodes holocyclus) envenomation.

The tube cricothyrotomy (CTT) has recently been introduced to small animal medicine as a viable surgical airway access procedure; however, there are no reports documenting its clinical use. The author's objective is to describe the clinical application, complications, and management of an elective CTT in a dog. Furthermore, the characteristics of CTT that may be clinically advantageous over temporary tube tracheostomy (TT) will be discussed. A 2-year-old female spayed German shepherd dog required mechanical ventilation (MV) due to unsustainable work of breathing as a result of tick paralysis and aspiration pneumonia. After successful weaning from MV, the dog was diagnosed with laryngeal paralysis. A surgical airway was performed using CTT to allow extubation and patient management whilst conscious. Complications included frequent tube suctioning due to accumulation of airway secretions in the tube and a single dislodgement event. The dog made an uneventful recovery with complete stoma healing by the second intention within 15 days. To the authors' knowledge, this is the first clinical report of an elective CTT performed to successfully manage upper airway obstruction in the dog. Its efficacy, clinical management and patient outcome are described.

Treatment of moderate grade dog bite wounds using amoxicillin-clavulanic acid with and without enrofloxacin: a randomised non-inferiority trial.

BACKGROUND: Dog-to-dog bite wounds are a common veterinary emergency presentation: despite this, there is insufficient information to guide veterinarians on appropriate empirical antimicrobial management. OBJECTIVES: Investigate the effectiveness of amoxicillin-clavulanic acid with and without enrofloxacin in the treatment of moderate grade dog bite wounds (DBW). To describe common pathogens and their antimicrobial susceptibility patterns. MATERIALS AND METHODS: In a single-centre parallel group pragmatic trial, 50 dogs presenting with moderate grade DBW were prospectively randomised to receive amoxicillin-clavulanic acid (group A) or amoxicillin-clavulanic acid and enrofloxacin (group B). Swabs were taken for culture and susceptibility testing at admission. Stabilisation, wound care and surgical debridement were performed at the discretion of admitting clinicians. The primary outcome was complication due to infection at 10 days, with Bayesian inference used to estimate the difference in proportions between treatment groups. RESULTS: Of the 24 dogs in treatment group A, 1 required the addition of enrofloxacin at re-examination. None of the 26 dogs in group B required alteration of antimicrobial coverage. The difference in complication rate due to infection between treatment groups was 4.2%. Twenty-one different organisms were identified: Staphylococcus pseudintermedius, Neisseria spp., Pasteurella multocida and P. canis were the most common. Over 90% of gram-negative and gram-positive isolates were susceptible to amoxicillin-clavulanic acid. Ninety-six percent of gram-negative and 86% of gram-positive isolates were susceptible to enrofloxacin. CONCLUSION AND CLINICAL SIGNIFICANCE: Amoxicillin-clavulanic acid is an appropriate empirical antimicrobial choice for moderate DBW in South East Queensland. Reduced empirical enrofloxacin use will promote antimicrobial stewardship and potentially antimicrobial resistance.

Anaphylaxis associated with intravenous administration of alphaxalone in a dog.

CASE REPORT: We describe the clinical signs and management of a case of anaphylaxis in a dog after intravenous administration of alphaxalone (Alfaxan®, Jurox, NSW, Aust), which has not been previously published. A female spayed cattle dog undergoing routine imaging for forelimb lameness was induced with Alfaxan after receiving sedation with acepromazine and methadone 70 min prior. Immediately after intravenous administration of Alfaxan, the dog exhibited vomiting and diarrhoea associated with acute hypotension. Gallbladder wall oedema was visualised consistent with anaphylaxis. The dog responded to rapid volume expansion. Adrenaline was not required. The dog made a full recovery within 6 h of the reaction and was re-anaesthetised 3 days later without incident, using propofol as the induction agent. CONCLUSION: To our knowledge, this is the first published case of anaphylaxis associated with intravenous Alfaxan in the dog. The APVMA reporting of reactions in small animals from 2003 to 2013 of Alfaxan is consistent with this case report's finding involving the respiratory, circulatory and gastrointestinal systems.

Microwave window breakdown experiments and simulations on the UM/L-3 relativistic magnetron.

Experiments have been performed on the UM/L-3 (6-vane, L-band) relativistic magnetron to test a new microwave window configuration designed to limit vacuum side breakdown. In the baseline case, acrylic microwave windows were mounted between three of the waveguide coupling cavities in the anode block vacuum housing and the output waveguides. Each of the six 3 cm deep coupling cavities is separated from its corresponding anode cavity by a 1.75 cm wide aperture. In the baseline case, vacuum side window breakdown was observed to initiate at single waveguide output powers close to 20 MW. In the new window configuration, three Air Force Research Laboratory-designed, vacuum-rated directional coupler waveguide segments were mounted between the coupling cavities and the microwave windows. The inclusion of the vacuum side power couplers moved the microwave windows an additional 30 cm away from the anode apertures. Additionally, the Lucite microwave windows were replaced with polycarbonate windows and the microwave window mounts were redesigned to better maintain waveguide continuity in the region around the microwave windows. No vacuum side window breakdown was observed in the new window configuration at single waveguide output powers of 120+MW (a factor of 3 increase in measured microwave pulse duration and factor of 3 increase in measured peak power over the baseline case). Simulations were performed to investigate likely causes for the window breakdown in the original configuration. Results from these simulations have shown that in the original configuration, at typical operating voltage and magnetic field ranges, electrons emitted from the anode block microwave apertures strike the windows with a mean kinetic energy of 33 keV with a standard deviation of 14 keV. Calculations performed using electron impact angle and energy data predict a first generation secondary electron yield of 65% of the primary electron population. The effects of the primary aperture electron impacts, combined with multiplication of the secondary populations, were determined to be the likely causes of the poor microwave window performance in the original configuration.

Role of ions in a crossed-field diode.

The effect of ions in a magnetically insulated crossed-field gap is studied using a single particle orbit model, shear flow model, and particle-in-cell simulation. It is found that, in general, the presence of ions in a crossed-field gap always increases the electrons' excursion toward the anode region, regardless of the location of the ions. Thus, the rate at which the electrons migrate toward the anode, which is a measure of the diode closure rate, is related to the rate at which ions are introduced into the crossed-field gap. This anode migration of electrons is unrelated to crossed-field ambipolar diffusion. The implications of these findings are explored, such as pulse shortening in relativistic magnetrons and bipolar flows in pulsed-power systems.

The prevalence of episodic pain in cancer: a survey of hospice patients on admission.

Pain that varies with time, referred to here as episodic pain, is a commonly encountered but under-investigated clinical problem. Previous studies of cancer patients have found that a significant proportion of their pains are episodic. To establish the prevalence and characteristics of episodic pains in hospice in-patients we assessed 245 consecutive admissions to four hospices in Yorkshire. The admitting doctor completed a questionnaire, detailing the characteristics of all pains experienced by the patient in the previous 24 h. Two hundred and forty-two questionnaires were entered into the study. One hundred and thirty-two patients reported pain in the preceding 24 h, of these 93% had at least one episodic pain. In total, 228 pains were described, of which 211 were episodic with a wide variation in their temporal characteristics, intensities and limitation. One hundred and fifty-two episodic pains had a precipitating factor; movement and weight bearing being the most frequent precipitants. One hundred and sixty-eight episodic pains had a relieving factor, medication improving 54%. Ninety-five pains were related to the malignancy and 47 to concurrent illness. The study confirms that episodic pain is extremely common in cancer patients referred for in-patient hospice care and highlights the need for further evaluation of its management.

Hospital-based community outreach to medically isolated elders. The nurse gerontologist is a key link in this health care delivery system in Wisconsin.

The development of a hospital-based community outreach nursing program has been beneficial for St. Mary's Hospital in several ways. The outreach program has served a community need in that many elderly persons who were previously medically isolated have now been located and linked to the health care delivery system. The outreach program has reinforced the hospital's presence and leadership role in the community through its work with the elderly population. The hospital is seen as being committed to bringing health care services to its elderly neighbors. Through the establishment and coordination of health care services to previously isolated and unconnected elderly persons, there has been a broadened revenue base for hospital operations. The outreach program also supports the mission, philosophy, and objectives of the Daughters of Charity. The efforts of this outreach program have shown that high-quality, accessible, and coordinated care for the elderly population may be obtained using a nurse gerontologist. Efforts to expand the market share of elderly persons by the hospital has continued through the development of other innovative health programs, resources, and services. Hospital administrators need to develop programs and services that effectively utilize limited health care dollars and resources to improve the quality of health care within the community.

Slow release carbamazepine in treatment of poorly controlled seizures.

Thirty three children with poorly controlled epilepsy, and six new patients, were treated with slow release carbamazepine. Twelve of the former had a reduction in the number of seizures of more than half, and 10 had fewer side effects. Three of the new patients stopped having seizures. Variations in plasma concentrations between doses was significantly less when patients took the slow release preparation (22%) compared with the standard preparation (41%). Slow release carbamazepine may improve the conditions of children whose seizures are poorly controlled.