Integrative veterinary medical education and consensus guidelines for an integrative veterinary medicine curriculum within veterinary colleges.

Integrative veterinary medicine (IVM) describes the combination of complementary and alternative therapies with conventional care and is guided by the best available evidence. Veterinarians frequently encounter questions about complementary and alternative veterinary medicine (CAVM) in practice, and the general public has demonstrated increased interest in these areas for both human and animal health. Consequently, veterinary students should receive adequate exposure to the principles, theories, and current knowledge supporting or refuting such techniques. A proposed curriculum guideline would broadly introduce students to the objective evaluation of new veterinary treatments while increasing their preparation for responding to questions about IVM in clinical practice. Such a course should be evidence-based, unbiased, and unaffiliated with any particular CAVM advocacy or training group. All IVM courses require routine updating as new information becomes available. Controversies regarding IVM and CAVM must be addressed within the course and throughout the entire curriculum. Instructional honesty regarding the uncertainties in this emerging field is critical. Increased training of future veterinary professionals in IVM may produce an openness to new ideas that characterizes the scientific method and a willingness to pursue and incorporate evidence-based medicine in clinical practice with all therapies, including those presently regarded as integrative, complementary, or alternative.

Ferret, rabbit, and rodent anesthesia.

Ferrets, rabbits, and rodents are increasingly being presented to veterinarians for evaluation and treatment. The owners of these animals expect high-level medical and surgical care. Consequently, veterinarians are more often required to provide intensive anesthetic management of these animals. The variability of anesthetic agents used and patient responses are addressed. The consequences of size for anesthetic management are discussed. Successful small mammal anesthesia requires following general anesthetic principles, awareness of limitations, and maintenance of high standards of care.

Inadvertent severe hypercarbia associated with anesthesia machine malfunction in one cat and two dogs.

Severe acute hypercarbia occurred in a cat and 2 dogs as a result of anesthesia machine malfunction. In each case, the anesthesia machine had been checked by the anesthesia technician and clinician, and no problems were found. After it was noticed that the same machine had been used on each animal, further investigation revealed an expiration valve that was functional with large breaths or positive pressure ventilation but was not functional with small breaths with low peak inspiratory flow. Rebreathing of expired carbon dioxide occurred, and the patients subsequently became severely hypercarbic. Recovery from anesthesia was prolonged in 2 animals, and cardiac and respiratory arrest occurred in the third. Hypercarbia from rebreathing can be detected through the use of blood gas analysis or end-tidal carbon monoxide monitoring.

HIV prevention programs with heterosexuals.

OBJECTIVE: Efficacious HIV prevention programs designed for heterosexual adults were identified. METHODS: Thirty-two programs designed with a comparison group and aimed at preventing heterosexual transmission for HIV were identified utilizing computerized data bases and key informants. RESULTS: Three types of efficacious interventions were identified: (1) those based on social cognitive theories that aimed to improve HIV-related knowledge, attitudes, norms, and behavioral practices (n = 27); (2) treatment of sexually transmitted diseases (STDs) (n = 3); and (3) pre- and post-test HIV testing and counseling programs (n = 2). The high incidence of HIV and STD in international settings has resulted in these trials demonstrating the greatest reductions in risk for HIV, reflected in biological markers of infection. Only five of 12 studies with injecting drug users were successful in reducing sexual risk behaviors. The optimal STD treatment strategy (syndromic case management, mass treatment) varies across communities. HIV testing and counseling appears an efficacious strategy, particularly for seropositive adults, yet current models have not considered the impact of new technologies on HIV testing paradigms. CONCLUSION: Each successful prevention strategy faces significant challenges before broad dissemination of the intervention approach can be achieved.

One-lung versus two-lung ventilation in the closed-chest anesthetized dog: a comparison of cardiopulmonary parameters.

OBJECTIVE: To evaluate cardiopulmonary effects of one-lung ventilation (OLV) versus two-lung ventilation (TLV) in closed-chest anesthetized dogs. STUDY DESIGN: Controlled, randomized experiment. ANIMALS: Fourteen, 2- to 7-year-old adult dogs, weighing 23 +/- 6 kg. METHODS: The dogs were anesthetized with acepromazine, morphine, thiopental, and halothane in oxygen, ventilated, and paralyzed with vecuronium. Tidal volume was 10 mL/kg. Respiratory rate was set to maintain end-tidal CO2 (ETCO2) at 40 +/- 2 mm Hg before instrumentation then not changed. The left bronchus of 7 dogs was obstructed with a Univent bronchial blocker (Fuji Systems Corp, Tokyo, Japan). Blood gas analysis and hemodynamic measurements were taken at predetermined intervals for 1 hour in the TLV group and at baseline and following bronchial obstruction in the OLV group. RESULTS: Shunt fraction was not significantly different between groups, but in OLV shunt increased from baseline at 5 minutes. Arterial oxygen (PaO2) decreased after baseline in OLV compared with TLV. Arterial carbon dioxide (PaCO2) increased with OLV and decreased with TLV. In OLV, systemic vascular resistance was variable and decreased compared with TLV. Cardiac index increased over time in both groups but was not affected by treatment. Heart rate, mean arterial pressure, and diastolic arterial pressure increased with OLV compared with TLV but did not change over time. CONCLUSION: This study shows that OLV statistically decreases oxygen tension and transiently increases shunt fraction, but with 100% O2 it appears to be a feasible procedure with minimal cardiopulmonary side effects in healthy dogs. CLINICAL RELEVANCE: OLV is a feasible procedure in anesthetized dogs to better facilitate thoracic procedures such as bronchopleural fistula repair and thoracoscopy.

Anesthesia of wood bison with medetomidine-zolazepam/tiletamine and xylazine-zolazepam/tiletamine combinations.

This study was designed to evaluate 2 combinations for immobilization of bison. Seven wood bison received 1.5 mg/kg body weight (BW) of xylazine HCl + 1.5 mg/kg BW of zolazepam HCl and 1.5 mg/kg BW of tiletamine HCl on one occasion. The bison received 60 micrograms/kg BW of medetomidine HCl + 0.6 mg/kg BW of zolazepam HCl and 0.6 mg/kg BW of tiletamine HCL on another occasion. Xylazine was antagonized with 3 mg/kg BW of tolazoline HCl and medetomidine HCl was antagonized with 180 micrograms/kg (BW) of atipamezole HCl. Temporal characteristics of immobilization and physiological effects (acid-base status, thermoregulatory, cardiovascular, and respiratory effects) of the drug combinations were compared. Induction was significantly faster with xylazine HCl-zolazepam HCl/tiletamine HCl. Recovery following antagonist administration was significantly faster with medetomidine HCl-zolazepam HCl/tiletamine HCl. The average drug volumes required were 7.00 mL of xylazine HCl-zolazepam HCl/tiletamine HCL and 2.78 mL of medetomidine HCl-zolazepam HCl/tiletamine HCl. Hypoxemia, hypercarbia, and rumenal tympany were the major adverse effects with both drug combinations.

Thoracoscopic versus open partial pericardectomy in dogs: comparison of postoperative pain and morbidity.

OBJECTIVE: To evaluate postoperative pain and morbidity in dogs undergoing open thoracotomy and partial pericardectomy versus thoracoscopic pericardectomy. STUDY DESIGN: Research study in normal dogs. ANIMALS OR SAMPLE POPULATION: Fourteen mixed breed healthy dogs. METHODS: Seven dogs had a partial pericardectomy through a standard left lateral thoracotomy at the fifth intercostal space. The remaining seven dogs underwent selective lung ventilation and thoracoscopic partial pericardectomy. Surgery sites in both groups were bandaged and each dog received a single postoperative dose of morphine (0.2 mg/kg, intramuscularly [i.m.]). Postoperative pain was evaluated using a standard pain score table at 1, 5, 9, 17, 29, and 53 hours after surgery. Dogs receiving a pain score of six or greater received an additional dose of morphine. At each observation point, blood samples were taken to measure blood glucose and plasma cortisol concentrations. Pain scores, blood glucose, and plasma cortisol concentrations were compared between the two groups using two-way ANOVA. RESULTS: Blood glucose concentrations, plasma cortisol concentrations, and pain scores were significantly different between the two groups, with the thoracotomy dogs having higher values at 1, 5, and 9 hours postoperatively. Three of the open thoracotomy dogs required additional analgesia after the initial dose of morphine. In addition, two dogs that underwent open thoracotomy were lame in the left forelimb and two others developed dehiscence of their wounds. CONCLUSIONS AND CLINICAL RELEVANCE: Thoracoscopic partial pericardectomy has several advantages over open partial pericardectomy including decreased postoperative pain, fewer wound complications, and more rapid return to function.

Intravenous regional anesthesia (Bier block) in a dog.

Intravenous regional anesthesia was used in an adult dog as part of a balanced approach to general anesthesia for amputation of the 4th digit of its right hind limb. It allowed the concentration of isoflurane to be reduced to 0.5%.

The effect of opioid and acepromazine premedication on the anesthetic induction dose of propofol in cats.

The median effective dosage (ED50) for induction of anesthesia with propofol was determined by using the up-and-down method in 31 unpremedicated cats, in 30 cats premedicated with butorphanol, 0.4 mg/kg body weight (BW), and acepromazine, 0.1 mg/kg BW, intramuscularly, and in 30 cats premedicated with morphine, 0.2 mg/kg BW, and acepromazine, 0.1 mg/kg BW, intramuscularly. The dose required for a satisfactory anesthetic induction in 50% of unpremedicated cats (ED50) was 7.22 mg/kg BW and of premedicated cats was 5.00 mg/kg BW. The reduction in dose was statistically significant in both premedicated groups compared with no premedication. There was no significant difference in ED50 between premedication regimes. Cyanosis was the most common adverse effect observed in all groups following anesthetic induction with propofol.

A comparison of indirect blood pressure monitoring techniques in the anesthetized cat.

OBJECTIVE: To determine the accuracy of three indirect blood pressure monitoring techniques (oscillometric technique [OS], Doppler [DOP], and optical plethysmography [OP] [blood pressure determined with a pulse oximeter waveform]) when compared with direct arterial pressure measurement in cats. STUDY DESIGN: Prospective study. ANIMAL POPULATION: Eight healthy (five female, three male), domestic short-hair cats weighing 3.5 +/- 0.8 kg METHODS: Cats were anesthetized with isoflurane. The inspired concentration of isoflurane was adjusted to produce mild hypotension (80 to 100 mm Hg direct systolic), moderate hypotension (60 to 80 mm Hg direct systolic), and severe hypotension (< 60 mm Hg direct systolic). Indirect pressure measurements were obtained from the thoracic limb and compared with concurrent direct measurement using regression analysis and a modification of Bland and Altman's technique. RESULTS: All three techniques underestimated systolic pressure. OS produced the best prediction of systolic pressure with a bias +/- precision of -15.9 +/- 8.1 mm Hg. DOP and OP were relatively inaccurate with a bias +/- precision of -25 +/- 7.4 mm Hg and -25 +/- 7.5 mm Hg. All three techniques correlated well with direct pressure with r values of 0.81, 0.88, and 0.88 for OS, DOP, and OP. DOP and OP provided an accurate prediction of direct mean arterial pressure with a bias +/- precision of -0.8 +/- 6 mm Hg and 0.6 +/- 5.5 mm Hg. Correlation was good between DOP and mean arterial pressure with r = 0.89. Correlation was also good between OP and mean arterial pressure with r = 0.90. CONCLUSIONS: OS provided the most accurate prediction of direct systolic pressure. DOP and OP provided a good prediction of mean arterial pressure in the cat. CLINICAL RELEVANCE: All three of these techniques are useful for detecting trends. Direct monitoring of blood pressure should be considered if accurate blood pressure measurement is required.

CD34+CD33- cells influence days to engraftment and transfusion requirements in autologous blood stem-cell recipients.

PURPOSE: To evaluate the reliability of CD34/CD33 subset enumeration as a predictor of hematopoietic repopulating potential in autologous blood stem-cell transplantation and to determine which patient and treatment-related factors affect the timing, quantity, and type of blood stem cells mobilized. PATIENTS AND METHODS: We analyzed blood stem-cell collections from 410 consecutive cancer patients who received mobilization therapy and evaluated factors, including CD34+ subset quantities, that might influence engraftment kinetics and transfusion requirements in autologous blood stem-cell recipients. RESULTS: The majority of patients (97%) mobilized CD34+33- cells, which were usually collected in the greatest quantity on the first day of apheresis. Patients who received only growth factor mobilized the highest percentage of CD34+33- cells. Extensive prior chemotherapy limited the collection of CD34+33- cells. In addition to patient diagnosis (P < .006) and total CD34+ cell dose (P = .0001), CD34+33- cell dose (P < .005) and percentage of CD34+33- cells (P < .005) were identified as independent factors significantly predictive of engraftment kinetics. CD34+33- cell dose (R2 < or = .177; P < .0001) was a strong and the only significant predictor of RBC and platelet transfusion requirements. Furthermore, independent of the total CD34+ cell dose, as the CD34+33- cell dose increased, days to neutrophil recovery, days to platelet recovery, and transfusion requirements decreased. CONCLUSION: These findings show that CD34+33- cells are readily collected in most cancer patients and significantly influence engraftment kinetics and transfusion requirements in autologous blood stem-cell recipients. CD34+33- cell quantity of the blood stem-cell graft appears to be a more reliable predictor of hematopoietic recovery rates than total CD34+ cell quantity in this setting.

Microbial growth on hydrocarbons: terminal branching inhibits biodegradation.

A variety of octane-utilizing bacteria and fungi were screened for growth on some terminally branched dimethyloctane derivatives to explore the effects of iso- and anteiso-termini on the biodegradability of such hydrocarbons. Of 27 microbial strains tested, only 9 were found to use any of the branched hydrocarbons tested as a sole carbon source, and then only those hydrocarbons containing at least one iso-terminus were susceptible to degradation. Anteiso-or isopropenyl termini prevented biodegradation. None of the hydrocarbonoclastic yeasts tested was able to utilize branched-hydrocarbon growth sustrates. In the case of pseudomonads containing the OCT plasmid, whole-cell oxidation of n-octane was poorly induced by terminally branched dimethyloctanes. In the presence of a gratuitous inducer of the octane-oxidizing enzymes, the iso-branched 2,7-dimethyloctane was slowly oxidized by whole cells, whereas the anteiso-branched 3,6-dimethyloctane was not oxidized at all. This microbial sampling dramatically illustrated the deleterious effect of alkyl branching, especially anteiso-terminal branching, on the biodegradation of hydrocarbons.

Biodegradation of acyclic isoprenoids by Pseudomonas species.

The ability of various pseudomonads to utilize acyclic isoprenoids as a sole carbon source was investigated. Tests for utilization of acyclic isoprenols such as citronellol and geraniol were complicated by toxic effects of these alcohols, and most species tested were killed by exposure to citronellol or geraniol (0.1%, vol/vol) in liquid culture. In the case of Pseudomonas citronellolis, sensitivity to isoprenols is reduced by prior induction of the isoprenoid degradative pathway via either growth on succinate in the presence of citronellol or growth on citronellic acid. For this species, citronellic acid proved to be the best isoprenoid growth substrate tested. Geraniol utilization as a taxonomic indicator for different subgroups of pseudomonads is discussed. Only a few of the species tested were able to utilize acyclic isoprenoids. Two species which utilize C10 acyclic isoprenoids, P. aeruginosa and P. mendocina, were shown to contain the inducible enzyme geranyl-coenzyme A carboxylase, one of the unique enzymes in the isoprenol degradative pathway known to occur in P. citronellolis. Of the species which utilized geranitol, none showed definite growth on the homologous C15 and C20 isoprenols.