Reduced incidence of tick paralysis cases in dogs and cats at two emergency clinics in South-East Queensland since 2015: new generation prophylactics as possible explanatory variables.

INTRODUCTION: This study aimed to determine the incidence of canine and feline tick paralysis cases presenting to two veterinary emergency hospitals before and after the introduction of new generation prophylactic acaricides. METHODS: This was a retrospective study, investigating the number of tick paralysis cases presenting to two emergency and critical care veterinary hospitals in South-East Queensland, from 2008 to 2021. A total of 10,914 dogs and 3696 cats were included over the course of the study. To assess if the introduction of new generation prophylactics in 2015 has coincided with any variation in case numbers, data for each species were analysed graphically and numerically in the first instance, then interrupted time series analyses were performed for the dog and cat data independently. RESULTS: Accounting for seasonal and climatic variation, we estimated a 54.8% reduction in dog (95% CI 45.3%-62.7%) and 44% reduction in cat (95% CI 19.5%-46%) tick paralysis cases presenting to these two clinics. This reduction corresponded with the timing of new generation prophylactic agents being introduced, including isoxazolines and imidacloprid/flumethrin impregnated collars. CONCLUSION: In the population studied, a significant reduction in the incidence of tick paralysis cases treated by veterinarians has occurred from 2015 onwards and was found to be associated with the timing of the release of new generation acaricidal products.

Sacral plexus catheter analgesia in a patient with traumatic sacral fractures and Tarlov cysts.

We report the use of a sacral plexus catheter for continuous local anaesthetic infusion in a patient with a unilateral sacral ala fracture following a fall from a horse. Although sacral plexus blockade has been well described for lower limb surgery, an ultrasound-guided continuous catheter technique for conservatively managed fractures has not been described. Despite appropriate oral analgesia, the patient reported severe pain, particularly in the right gluteal region, which meant she was unable to sit upright or take deep breaths. A sacral plexus catheter was inserted with ultrasound guidance and an initial bolus of 30 ml levobupivicaine 0.25% was delivered followed by infusion of 8 ml.h-1 levobupivicaine 0.125%. Daily follow-up and assessment were provided by the acute pain team. We judged the procedure to be a success as measured by an improvement in mobilisation, deep breathing, cough and patient satisfaction.

Long-term endometrial effects in postmenopausal women with early breast cancer participating in the Intergroup Exemestane Study (IES)--a randomised controlled trial of exemestane versus continued tamoxifen after 2-3 years tamoxifen.

BACKGROUND: The antiestrogen tamoxifen may have partial estrogen-like effects on the postmenopausal uterus. Aromatase inhibitors (AIs) are increasingly used after initial tamoxifen in the adjuvant treatment of postmenopausal early breast cancer due to their mechanism of action: a potential benefit being a reduction of uterine abnormalities caused by tamoxifen. PATIENTS AND METHODS: Sonographic uterine effects of the steroidal AI exemestane were studied in 219 women participating in the Intergroup Exemestane Study: a large trial in postmenopausal women with estrogen receptor-positive (or unknown) early breast cancer, disease free after 2-3 years of tamoxifen, randomly assigned to continue tamoxifen or switch to exemestane to complete 5 years adjuvant treatment. The primary end point was the proportion of patients with abnormal (> or =5 mm) endometrial thickness (ET) on transvaginal ultrasound 24 months after randomisation. RESULTS: The analysis included 183 patients. Two years after randomisation, the proportion of patients with abnormal ET was significantly lower in the exemestane compared with tamoxifen arm (36% versus 62%, respectively; P = 0.004). This difference emerged within 6 months of switching treatment (43.5% versus 65.2%, respectively; P = 0.01) and disappeared within 12 months of treatment completion (30.8% versus 34.7%, respectively; P = 0.67). CONCLUSION: Switching from tamoxifen to exemestane significantly reverses endometrial thickening associated with continued tamoxifen.

Survival and safety of exemestane versus tamoxifen after 2-3 years' tamoxifen treatment (Intergroup Exemestane Study): a randomised controlled trial.

BACKGROUND: Early improvements in disease-free survival have been noted when an aromatase inhibitor is given either instead of or sequentially after tamoxifen in postmenopausal women with oestrogen-receptor-positive early breast cancer. However, little information exists on the long-term effects of aromatase inhibitors after treatment, and whether these early improvements lead to real gains in survival. METHODS: 4724 postmenopausal patients with unilateral invasive, oestrogen-receptor-positive or oestrogen-receptor-unknown breast cancer who were disease-free on 2-3 years of tamoxifen, were randomly assigned to switch to exemestane (n=2352) or to continue tamoxifen (n=2372) for the remainder of a 5-year endocrine treatment period. The primary endpoint was disease-free survival; overall survival was a secondary endpoint. Efficacy analyses were intention-to-treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN11883920. RESULTS: After a median follow-up of 55.7 months (range 0-89.7), 809 events contributing to the analysis of disease-free survival had been reported (354 exemestane, 455 tamoxifen); unadjusted hazard ratio 0.76 (95% CI 0.66-0.88, p=0.0001) in favour of exemestane, absolute benefit 3.3% (95% CI 1.6-4.9) by end of treatment (ie, 2.5 years after randomisation). 222 deaths occurred in the exemestane group compared with 261 deaths in the tamoxifen group; unadjusted hazard ratio 0.85 (95% CI 0.71-1.02, p=0.08), 0.83 (0.69-1.00, p=0.05) when 122 patients with oestrogen-receptor-negative disease were excluded. CONCLUSIONS: Our results suggest that early improvements in disease-free survival noted in patients who switch to exemestane after 2-3 years on tamoxifen persist after treatment, and translate into a modest improvement in overall survival.

Dental benefits--expanding access to dental care.

The Executive Director of the National Association of Dental Plans presents statistics describing recent trends in product mix, growth in voluntary benefits and referral plans, geographic concentration, and industry consolidation in the dental benefits industry. Current issues include dental workforce, the economy, human resources policies, and regulation. The issue of quality oral health care is identified as needing consensus definition by the entire dental industry.

Modification of a vinyl glove into a dental dam for patients sensitive to latex rubber.

Dental products containing latex rubber such as rubber dams, gloves, polishing points, prophy cups, blood pressure cuffs, orthodontic elastics, mouth props, intubation tubes, and anesthetic masks have the potential to cause allergic reactions. The clinician should try to identify patients at high risk for latex sensitivity by taking a careful history and, where necessary, using alternative products. This paper describes how a vinyl glove can be easily modified to provide an effective dental dam in patients allergic to latex rubber.

Surviving the bite of health care reform: the future for dental benefits.

Dental benefits are not in the eye of the storm over cost and availability of health benefits. However, actions to reform health care on the state and federal level will affect the dental benefit market. Rather than having a direct effect, the potential is for health care reform to inadvertently devastate the dental benefits market and reduce the overall oral health of the nation.

Explorer sharpness as related to margin evaluations.

Nine experienced operative dentistry faculty each used six different explorers of varying degrees of sharpness ranging from new to well-used to evaluate marginal acceptability on a device used to simulate gradations of vertical opening. In this study, the standard for the sharpest explorer point was determined to be 68 microns in diameter measured 40 microns from the tip. There was a positive correlation between the diameter of the explorer tip at 40 microns and the mean amount of opening that could be detected until the margin was declared unacceptable. Increased explorer dullness significantly handicapped even experienced graders when the explorer alone was used to evaluate visually inaccessible margins.

Fabrication of a crown to fit an existing partial denture using castable glass.

In this case report, an accepted technique was used to fabricate a crown to fit an existing removable partial denture in which castable glass was used instead of gold. The use of castable glass allowed the crown to be cast directly from a wax-acrylic pattern and eliminated the need for templates to produce accurate facial contours in porcelain. Although castable glass has limitations and cannot be used in all such situations, the material can be used in selected cases where esthetics is important.

Becoming a more compassionate dentist by improving interpersonal skills.

Because of exposure to violence and other acts of inhumanity common today, there is a danger that the dentist could lose sensitivity for members of society and some sense of what it means to be human. This article reviews possible actions a dentist can take to ensure that the patient receives necessary attention during treatment.

Can dentists recognize their own work? The forensic implications.

After 10 months, 71.4% of a group of dental students were able to recognize amalgam restorations that they had placed in the mouths of manikins. After 24 months, 57.1% of the group were able to recognize their work again. In contrast, only 5.5% of a second group of students, who did not have the interim viewing at 10 months, could recognize their work at 24 months. These results suggest that, with time, dental operators lose the ability to recognize their work but that this ability is prolonged by interim observations of the work. This study underscores the need for dentists to chart and record accurately any artifacts introduced into the patient's mouth, as well as any features that would make the patient unique upon forensic examination.

Ureteric endometriosis: 3 case reports and a review of the literature.

Endometriosis involving the ureter is a relatively rare phenomenon but at least 121 cases have been reported previously. The 3 cases presented in this report emphasize some important facets of this condition: the lack of symptoms leading to late diagnosis, the presence of severe renal damage with very localized pelvic disease, how an incomplete initial operation may lead to further major difficulties, and the failure of medical therapy to halt its progress. The potentially lethal nature of ureteric endometriosis is stressed, and the different treatment modalities for patients of different ages and parity discussed. Surgical management, either conservative or radical, is suggested as the modality of choice, and where conservative operation is undertaken very careful continuing observation of renal function is a necessity.