[Severe cardiac malformation with secondary polycythemia in a 5-month old calf]. / Herzmissbildung mit sekundärer Polyzythämie bei einem 5 Monate alten Kalb.

A 5-month old female Red-Holstein calf in poor condition was presented with a history of reduced appetite, respiratory disease and collapse. Clinical examination revealed an elevated heart rate and pronounced cyanosis of the mucous membranes. Heart and lung auscultation were normal. A complete blood count revealed profound polycythemia with severely increased values for packed cell volume, hemoglobin concentration and erythrocyte count. Cardiac ultrasonography revealed abnormal position of the great vessels with two arteries located in the right ventricle output tract and a high ventricular septum defect (VSD). Intracardial pressure and blood gas measurements confirmed pressure overload in the right heart, a left-to-right shunt through the VSD and a right-to-left-shunt leading to hypoxemia and secondary polycythemia. Based on poor prognosis, the animal was euthanized. Post-mortem examination confirmed the results of the further investigations conducted to determine the cause of polycythemia in this calf.

Barriers to Swiss guideline-recommended cholesterol management in general practice.

BACKGROUND: Standard guidelines for the management of dyslipidaemia are often not followed in general practice. The reasons for guideline non-adherence are not known. METHODS: Charts of 1000 consecutive unselected patients of 20 general practitioners in northwestern Switzerland were reviewed. An independent committee of experienced study physicians checked the data and assessed the reasons for not measuring plasma cholesterol and for not treating dyslipidaemia as recommended by guidelines. RESULTS: Complete data of 866 patients were studied. 29% of all patients qualified for secondary prevention. 6% had no additional cardiovascular risk factors (apart from cholesterol values), 24% had one and 41% had 2 or more additional cardio- vascular risk factors. Guidelines were followed in 44% of all cases and were not followed in 56%. In 37.5% of all cases we found diagnostic guideline non-adherence, and in 10% only treatment guideline non-adherence. 8.5% of all patients had both diagnostic and treatment non-adherence. The main reasons for diagnostic non-adherence were relevant comorbidity (45%) and GPs' belief that the risk did not require screening (42%). The main reasons for treatment non-adherence were GPs' belief that the risk did not require treatment (42%) and relevant comorbidity (38%). CONCLUSION: More than half of all patients aged 35-80 years are not screened or treated according to current guidelines. The reasons are to an equal extent patient-related (relevant comorbidity) and physician-related (acceptance and knowledge of guidelines). These reasons should be considered when programmes to improve the quality of GPs' adherence to guidelines are implemented.

Prescribed medications and pharmacy interventions for acute respiratory tract infections in Swiss primary care.

BACKGROUND AND OBJECTIVES: Symptomatic medications are often not considered in clinical studies assessing interventions to reduce prescribing of antibiotics for acute respiratory tract infections (ARTI). Our study objectives were to examine prescribing patterns of antibiotics and symptomatic medications for ARTI in Swiss primary care and to monitor pharmacists' interventions during the prescription-dispensing process. METHODS: Medical records of 695 patients participating in a clinical trial which was designed to reduce use of antibiotics for ARTI in primary care, were linked to their prescriptions. Matching of prescribed and dispensed medications enabled the assessment of interventions by community pharmacists. RESULTS: On average, 2.4 different drugs were prescribed per patient (in total 142 antibiotics, 1599 symptomatic medications, and 56 non-ARTI-medication). Most patients (80%) were treated only with symptomatic medications. Most frequently prescribed symptomatic ARTI-medications were nasal decongestants (39%), cough suppressants (36%), and mucolytics (31%). Patients with prescribed antibiotics received significantly fewer symptomatic medications (odds ratio, 0.24; 95% confidence interval 0.16-0.37). Over 20% of prescriptions prompted at least one intervention by a pharmacist in the dispensing process. A discrepancy between prescribed and dispensed medications was seen in 19% of patients. CONCLUSIONS: Prescription rates of antibiotics for ARTI in this trial were low and patients were treated mainly with non-antibiotic symptomatic medications. Efforts to reduce antibiotic prescribing may induce higher rates of use of medications for intensive symptomatic treatment. Considerable differences between prescribed and dispensed medications were noted.

Twenty-four hour ambulatory blood pressure for the management of antihypertensive treatment: a randomized controlled trial.

The aim of this study was to assess whether the use of 24-h blood pressure (BP) measurement in the management of antihypertensive therapy improves BP in patients with sustained hypertension. Patients with sustained hypertension (office BP > or =140/90 mm Hg, and 24-h systolic BP > or =130/80 mm Hg) were randomly assigned to a strategy using 24-h BP to manage antihypertensive treatment (target <130/80 mm Hg) or to a standard strategy using office BP (target <140/90 mm Hg). The primary end point was change in 24-h systolic BP at 1 year of follow-up. We included 136 patients in the primary analysis. After 1 year of follow-up, the change in 24-h systolic BP was significantly greater in the ambulatory BP group compared with the office BP group (mean difference (95% confidence interval) -3.6 (-7.0, -0.3), P=0.03). Intention-to-treat analysis revealed essentially unchanged results. The mean number of antihypertensive drugs per participant at 1 year of follow-up was 1.76+/-1.1 and 1.95+/-0.9 in the ambulatory and office BP group, respectively (P=0.049). The benefit of ambulatory BP monitoring was mainly seen in patients with previously known hypertension (mean difference -7.2 (-11.6, -2.8), P=0.002), but not in those with newly detected hypertension (mean difference 0.2 (-4.9, 5.4), P=0.93). In conclusion, using 24-h BP for the management of antihypertensive therapy in patients with sustained hypertension leads to a greater BP reduction compared with a standard treatment strategy using office BP, although fewer antihypertensive drugs were used in the ambulatory BP group.

[False non-response in hypertensive patients treated in general practice]. / Falsch-Non-Response bei Hypertonie-Behandlung in der Hausarztpraxis.

Many hypertensive patients still have elevated blood pressure values despite antihypertensive treatment. However, which patients really do not respond to antihypertensive treatment? 41 primary care patients with treated essential arterial hypertension with office blood pressure > 140/90 mmHg received 24-hour ambulatory blood pressure measurement. The patients were categorized into a group with elevated blood pressure both in office (> or = 140/90 mmHg) and daytime ambulatory blood pressure measurement (> 135/85 mmHg) and into a group with False Non-Response to treatment (office blood pressure > or = 140/90 mmHg but normal daytime mean ambulatory blood pressure < 135/85 mmHg). Patients in the group with False NonResponse were significantly more likely to be female compared to patients with both office and ambulatory hypertension (67% vs. 23%, p = 0.009), whereas diabetes mellitus was a significant predictor of elevated blood pressure both in office and ambulatory measurement (7% vs. 39%, p = 0.033). False-Non-Response is common in primary care patients treated for hypertension. These patients have normal ambulatory BP values despite elevated office BP values. Female gender and absence of diabetes mellitus are significant predictors of False Non-response to antihypertensive treatment.

[Cardiovascular prediction rules: problems for application in practice results of a workshop]. / Kardiovaskuläre "Prediction rules": Was sind Probleme bei der Anwendung? Resultate der Diskussion in einem Workshop.

Guidelines for primary prevention of cardiovascular disease recommend a management based on global cardiovascular risk calculated with prediction rules. While cardiovascular prediction rules are applied as a tool to estimate risk, Guidelines describe which consequences to be drawn based on this risk information. We performed a workshop to discuss open questions for application of prediction rules in primary care. Technical aspects may not be a problem, however, additional barriers for application in daily routine exist. First, accuracy of risk estimation is unclear for some of the prediction rules. Second, risk factors, which are intuitively relevant (like obesity), are lacking in most of the prediction rules. Third, differences between guidelines and prediction rules are sometimes not clear for the general physician. In this article we want to answer the most important questions, which have been discussed during the workshop.

[South American camelids in Switzerland. II. Reference values for blood parameters]. / Neuweltkameliden in der Schwei. II. Referenzwerte für hämatologische und blutchemische Parameter.

In order to establish reference values for blood parameters of South American camelids in Switzerland, 273 blood samples were collected from 141 llamas and 132 alpacas. These animals were classified in three categories (young animals < six months, adult females and males). Forty-one parameters were measured (red blood cell count, white blood cell count, electrolytes, metabolites and enzymes). Significant differences between llamas and alpacas were evident for 26 parameters. This study also showed that differences between young animals, females and males must be taken into consideration. A comparison of blood values with the results of fecal analysis for parasite eggs showed that an infestation with Dicrocoelium dendriticum was associated with elevated activity of two liver enzymes (GLDH and gamma-GT) in the serum. In contrast, no differences were found in the results of blood analyses between animals shedding eggs of gastrointestinal strongyles or not.

Pharmacokinetics and pharmacodynamic effects of amiodarone in plasma of ponies after single intravenous administration.

Atrial fibrillation is a well-known heart disease in horses. The common therapy consists of administration of quinidine. More potent antiarrhythmic drugs have become available for human therapy and the use of these as alternatives to quinidine for equine antiarrhythmic therapy is a matter of interest. Amiodarone (AMD) is used in human medicine for treatment of many arrhythmias, including atrial fibrillation. Its disposition in horses has not yet been investigated. The purpose of this study was to measure the effect of single intravenous doses of amiodarone (5 and 7 mg/kg) on the surface electrocardiogram (ECG) of healthy minishetland ponies during the first 2 days after drug administration and to calculate pharmacokinetic parameters with a physiologically based pharmacokinetic model (PBPK) using amiodarone and desethylamiodarone (DAMD) plasma levels that were determined by high-performance liquid chromatography (HPLC). As expected for a K(+)-channel-blocker, the main effect on the measured ECG could be seen on the ventricular complex, as the QT interval and the T wave showed statistically significant alterations. The doses investigated were well tolerated clinically. Results from the pharmacokinetic model were found to compare well with literature data of rats, dogs, and humans. It showed a rapid distribution in the tissue, beginning with the rapidly perfused tissue, like the heart, followed by slowly perfused tissues, and finally an accumulation in fat. The half-life for total elimination was calculated to be 16.3 days with 99% eliminated by 97 days. The model predicts that approximately 96% of amiodarone is eliminated as desethylamiodarone in urine, 2% eliminated as desethylamiodarone in bile, and 2% as other metabolites.

[Internet communication between family physicians and the university hospital]. / Internet-Kommunikation zwischen Hausärzten und Universitätsspital.

The potential of electronic communication in medicine is assessed based on an analysis of a pilot project pertaining to internet based communication among referring and hospital physicians. Advantages of electronic data exchange in medicine pertain to speed and capacity for data transfer, availability of data and data integration, ultimately enabling consistent medical case management. Quality requirements of electronic communication of medical data are related to safety, availability, data integration, potential for case management and system qualities. Medical efficiency can be increased by use of electronic communication only if complex functions beyond the substitution of conventional mail by e-mail are implemented and an exhaustive use of the technology can be achieved.

[Pneumonia in calves: characterization of the bacterial spectrum and the resistance patterns to antimicrobial drugs]. / Kälberpneumonien: Aktualisierung des bakteriellen Erregerspektrums und der Resistenzlage gegenüber antimikrobiellen Wirkstoffen.

The population under study included young calves with pneumonia (group A, n = 13) and their controls (group B, n = 9), as well as older calves from which the lungs with (group C, n = 90) or without (group D, n = 10) lesions were collected after slaughter. Arcanobacterium pyogenes was the organism most commonly isolated from calves in group A (46%), followed by Haemophilus somnus (23%), Mannheimia haemolytica (15%), Streptococcus suis and Pasteurella multocida (7.7% each). Only S. suis (22%) and P. multocida (11%) were found in group B. P. multocida was isolated from 32% group C calves, H. somnus from 11%, A. pyogenes from 7.8%, M. haemolytica from 2.2% and S. suis from 1.1%. No specific pathogens were isolated in group D. Prevalence of Mycoplasma bovis infection was 69% in group A and 37% in group C. Ninety-eight strains were tested for resistAnce to antibiotics. Resistance to penicillin and ampicillin was present only in M. haemolytica (46%). High percentages of resistant strains were observed for streptomycin (48-100%), tetracycline (15-43%), sulfonamides alone (14-100%) or in combination with trimethoprim (0-100%). Therapeutic approaches to bacterial calf pneumonia in the area under study should be modified according to the isolated bacterial population, the observed antimicrobial resistances and the growing importance of Mycoplasma bovis.

[Double outlet right ventricle (DORV) in a 15 month old heifer]. / Double outlet right ventricle (DORV) bei einem 15 Monate alten Rind.

The clinical findings, results of further investigations and necropsy of a 15-month old heifer with multiple congenital heart defects are presented. The symptoms were caused by a high ventricle septum defect and a hypoplastic, completely dextroponed aorta (DORV). Hematology, radiology and ultrasonography findings, right heart and pulmonary blood pressure, and blood gas measurements, as well as electro- and phonocardiograms are presented. The consequences of the multiple cardiac anomalies for the pulmonary circulation are described.

[Diagnosis and antibiotic therapy of infections in outpatients]. / Abklärung und Antibiotikatherapie von Infektionen in der Hausarztpraxis.

BACKGROUND: The study aim was to analyse the diagnostic and therapeutic approach to selected infectious diseases, in particular with regard to the use of antibiotics, in the light of current guidelines and the problem of developing resistance. METHODS: A questionnaire was sent to all physicians with a general or internal medicine practice in the Cantons Basel-Stadt and Basel-Landschaft, Switzerland. RESULTS: Of 440 physicians, 286 (65%) took part in the study. The most frequent diagnoses of infection were cystitis (16.6%), flu-like syndrome (16.4%), acute bronchitis (12.3%), and tonsillopharyngitis (10.1%). The most frequent indications for antimicrobial therapy were cystitis (19.9%), acute sinusitis (14.1%), acute bronchitis (11.5%), and tonsillopharyngitis (9.2%). Macrolides (24.0%), aminopenicillins (22.6%), and fluoroquinolones (16.8%) were the most frequently prescribed antibiotics. CONCLUSIONS: The majority of physicians diagnosed and treated according to rational principles. However, a few exceptions were found, e.g. omission of x-ray in the diagnosis of pneumonia (24%), the use of antibiotics in the treatment of viral diseases and antibiotic therapy for tonsillopharyngitis despite a negative rapid antigen detection test against group A streptococci (75%).

[Investigations on renal excretion of sodium in dairy cattle]. / Untersuchung zur renalen Ausscheidung von Natrium bei Milchkühen.

Serum and urine were taken from healthy dairy cattle from 22 different farms. 214 animals belonged to the Swiss Brown breed and 210 were crossbreds of Simmental-Red Holstein. The animals were given at least 70 g of sodium chloride with their daily feed ration. On 6 farms sodium chloride was offered ad libitum in form of licks, which was presumed to be sufficient for covering their needs. Concentrations of sodium (UR Na), potassium (UR K) and creatinine were analyzed from serum and urine and fractional excretion of Na and K was calculated. Concentrations of sodium and potassium in urine from all cows (mean +/- sd) was 60.9 +/- 44.7 mmol/l and 370.7 +/- 66.9 mmol/l respectively. The FE values were 0.954 +/- 0.939% for sodium and 173.1 +/- 54% for potassium. In 5.5% of the animals values for UR Na < 10 mmol/l were found. There were no significant differences, however, were found in sodium and potassium excretion among farms. Urine samples of at least 10 animals should be analyzed in order to have a reliable estimation of the supply with sodium chloride within a herd. Our results do not support the hypothesis that low sodium excretion would be a predisposing factor for Bovine Dilative Cardiomyopathy in Simmental-Red Holstein cattle.

Total serum IgE and IgA antibody levels in healthy dogs of different breeds and exposed to different environments.

Total serum immunoglobulin (Ig) E and A levels were analysed in 233 healthy dogs as basis for comparison with atopic dogs in future studies. They were measured by ELISA in a group of non- colonised dogs of various breeds (group A) and three groups of colonised dogs including one German Shepherd and two Beagle kennels (groups B-D). IgE levels from non-colonised dogs were significantly higher than the ones of German Shepherds and Beagles C (P<0.05). IgA levels were alike in all groups except for the German Shepherds which displayed the lowest levels. Age and sex were not identified as common significant cofactors for IgE and IgA levels in all groups and IgE levels correlated negatively with IgA only in non-colonised dogs. In conclusion, IgE and IgA levels seem to be mainly influenced by genetic background. Thus use of total serum IgE as a diagnostic tool in the atopic dogs required extensive family data and therefore appears most suitable for research purposes within specific, well defined dog populations.

[Evaluation of the portable blood analyser i-STAT]. / Evaluation des tragbaren Blutanalysators i-STAT.

The purpose of this study was to compare the results of horse blood examinations on a portable blood analysis system, i-STAT SDI, with conventional laboratory equipment and to verify the accuracy and precision. The precision within run was high and the coefficients of variation ranged from 0 to 3.85%. The comparative analysis of patient samples with routine methods showed a very strong positive correlation with correlation coefficients above 0.96 for blood gases, pH, glucose, urea, hemoglobin, hematocrit, sodium and potassium, with the exception of chloride where it was 0.867. The i-STAT system provides a quick and accurate stable-side evaluation of laboratory data in critically ill horses and emergency situations.

Biochemical markers of bone metabolism in draught and warmblood horses.

Concentrations of the cross-linked carboxyterminal telopeptide of type I collagen (ICTP) and osteocalcin (OC) have been determined in the serum of one hundred clinically healthy adult Draught or Warmblood horses. The correlation between these two markers has been evaluated and the influence of gender, age and type of horse described. No significant variations were observed between animals of different sex, but a significant inverse correlation (P < 0.0001) with age was observed for both measured parameters. After correction for age, serum levels of OC were found to be lower in Draught [adjusted least square mean (LSM) = 6.612 micrograms.L-1] than in Warmblood horses (adjusted LSM = 8.596 micrograms.L-1), whereas levels of ICTP were higher in Draughts (adjusted LSM = 8.035 micrograms.L-1) than in Warmbloods (adjusted LSM = 6.643 micrograms.L-1). A significant correlation (P < 0.0001) was observed between OC and ICTP. This correlation was stronger if the type of horse was taken into account in the statistical model. The ratio OC:ICTP was independent of gender and age. A higher OC:ICTP ratio in Warmbloods compared to the Draught horses might reflect a higher bone remodelling level of horses submitted to regular daily work. It was concluded that ICTP and OC are influenced by the type of horse, and probably reflect a physiological difference in bone remodelling between these animals.

Influence of type and breed of horse on serum osteocalcin concentration, and evaluation of the applicability of a bovine radioimmunoassay and a human immunoradiometric assay [corrected].

OBJECTIVES: To evaluate applicability of a human osteocalcin (OC) immunoradiometric assay (IRMA) for use with equine serum and compare it with a bovine radioimmunoassay (RIA) previously proven valid for such samples, and to describe the effect of type and breed of horses on serum OC concentration. ANIMALS: 100 healthy horses of either sex, classified as type I or II (draught or warmblood, respectively). Each type was represented by 2 breed groups, each comprising 25 horses. PROCEDURE: Blood samples were collected in the morning, and the serum was separated. Osteocalcin was measured, using commercially available RIA and IRMA kits, according to the manufacturer's instructions. All samples were evaluated in duplicate. RESULTS: The human IRMA did not recognize equine OC. Significant variations in the bovine RIA results were observed between types of horses. Draught horses had lower OC concentration, compared with warmblood horses. Significant difference was not observed between breeds for type of horse. Sex had no influence on serum OC values, but age was a significant covariable for both types of horses. CONCLUSIONS: No crossreactivity exists between the equine and human amino- and/or carboxy-terminus of OC, using this particular human IRMA kit. Difference in blood OC concentration exists between draught and warmblood types of horses. CLINICAL RELEVANCE: Use of this human IRMA kit is not valid for equine serum. Horse type must be taken into account when evaluating OC concentration in research or clinical situations, especially if small variations in OC concentration are expected.

Ultrasound spirometry in the horse: a preliminary report on the method and the effects of xylazine and lobeline hydrochloride medication.

A new computerised ultrasound-based spirometry system according to Buess et al. (1995) modified by a double flow measurement facility was used to study pulmonary function in healthy horses and horses affected with subclinical and manifest chronic bronchiolitis (CB). The horses were first evaluated at rest without any medication. On another occasion all horses were tested following i.v. administration of xylazine (0.4 mg/kg) and following i.v. administration of lobeline hydrochloride (l.hy.; 0.2 mg/kg) to evaluate the effect of xylazine and l.hy. on different spirometric variables. Ultrasound-based spirometry proved to be an easily applicable method for lung function testing, even in difficult horses. However, there existed a pronounced physiological variation for all measured lung function parameters and no significant differences between healthy horses and horses with chronic bronchiolitis could be found except for the expiratory tidal volume (VTE p < 0.05). Individually, a marked decrease of variability from breath to breath following either xylazine and l.hy. administration could be observed for all parameters, except the flow-time-ratio (Tpef./ Texp.) and the flow-volume-ratio (Vpef./Vexp).