New recommendations for self-locking barriers to reduce skin injuries in dairy cows.

The design of self-locking barriers can affect cows' skin injuries and impair welfare. This study aimed to propose and refine recommendations, expressed relatively to the cows' dimensions, for self-locking barrier design to reduce risks for skin injuries on the neck/shoulder/back and on carpus of dairy cows. We recorded individual body dimensions and the dimensions of self-locking barriers (e.g. top rail height) and assessed skin injuries on 3801 cows from 131 loose-housing dairy farms. We explored the significant associations between presence/absence of skin injuries and self-locking barrier dimensions using weighted multivariable logistic regression, taking into account the diversity of feeding barriers within each farm. The robustness of the models was assessed by cross-validation. Cows had skin injuries mainly on the neck/shoulder/back (29.0%) and, to a lesser extent, on the carpus (14.0%). The final multivariable logistic regression models comprised 13 factors for skin injuries on the neck/shoulder/back, and 11 factors for skin injuries on the carpus. Skin injuries were significantly reduced when the self-locking barriers were inclined (neck/shoulder/back) and when the cows used a feeding table (i.e. flat) instead of a feeding manger or cribs (i.e. hollow) (carpus). A top rail height >1.05 × cow height (measured at withers) was significantly associated with fewer skin injuries on the neck/shoulder/back and on carpus. Skin injuries on the neck/shoulder/back and carpus were significantly reduced when the bottom rail was on the food side relative to the wall, and at a height <0.39 of cow height. Skin injuries were significantly less frequent when the separation wall had no sharp edges on the food side (neck/shoulder/back), was >0.4 of cow height (carpus), was thinner than 15 cm (neck/shoulder/back and carpus) and when the height of the feeding step was 0.04 to 0.1 of cow height (neck/shoulder/back) and the length of the feeding step was <0.2 of cow length (carpus). A headlock articulation nut positioned between 0.62 and 0.78 of cow height significantly reduced skin injuries on the neck/shoulder/back. Here, by combining the diversity of on-farm self-locking barriers and their respective dimensions, we were able to refine the International Commission of Agricultural and Biosystems Engineering recommendations for self-locking barrier design and to propose new ones. This information now needs to be confirmed on other datasets, but can already help farmers and dairy industry stakeholders improve the design of self-locking barriers to improve dairy cow welfare.

Aggregation of measures to produce an overall assessment of animal welfare. Part 1: a review of existing methods.

Several systems have been proposed for the overall assessment of animal welfare at the farm level for the purpose of advising farmers or assisting public decision-making. They are generally based on several measures compounded into a single evaluation, using different rules to assemble the information. Here we discuss the different methods used to aggregate welfare measures and their applicability to certification schemes involving welfare. Data obtained on a farm can be (i) analysed by an expert who draws an overall conclusion; (ii) compared with minimal requirements set for each measure; (iii) converted into ranks, which are then summed; or (iv) converted into values or scores compounded in a weighted sum (e.g. TGI35L) or using ad hoc rules. Existing methods used at present (at least when used exclusively) may be insufficiently sensitive or not routinely applicable, or may not reflect the multidimensional nature of welfare and the relative importance of various welfare measures. It is concluded that different methods may be used at different stages of the construction of an overall assessment of animal welfare, depending on the constraints imposed on the aggregation process.

Aggregation of measures to produce an overall assessment of animal welfare. Part 2: analysis of constraints.

The overall assessment of animal welfare is a multicriterion evaluation problem that needs a constructive strategy to compound information produced by many measures. The construction depends on specific features such as the concept of welfare, the measures used and the way data are collected. Welfare is multidimensional and one dimension probably cannot fully compensate for another one (e.g. good health cannot fully compensate for behavioural deprivation). Welfare measures may vary in precision, relevance and their relative contribution to an overall welfare assessment. The data collected are often expressed on ordinal scales, which limits the use of weighted sums to aggregate them. A sequential aggregation is proposed in the Welfare Quality® project, first from measures to welfare criteria (corresponding to dimensions with pre-set objectives) and then to an overall welfare assessment, using rules determined at each level depending on the nature and number of variables to be considered and the level of compensation to be permitted. Scientific evidence and expert opinion are used to refine the model, and stakeholders' approval of general principles is sought. This approach could potentially be extended to other problems in agriculture such as the overall assessment of the sustainability of production systems.

Cubicle housing systems for cattle: Comfort of dairy cows depends on cubicle adjustment.

Housing is important for the welfare of cows. Although recommendations have been proposed, abnormal movements and injury problems are still observed in cubicle houses. We conducted a survey on 70 French dairy farms that used cubicles. We examined the design of the cubicles, and the behavior, injuries, and cleanliness of the cows. Most of the cubicles did not comply with the recommendations, often being too narrow and/or too short. Difficulties in lying behavior and injuries were more common when the neck rail was high. No improvement was noted when cubicles of a recent design were used ("U.S." cubicles), apparently because these cubicles were most often cantilevered on a double head rail rather than fixed on freestanding posts. An experiment was conducted, making similar measurements, on 84 cows to compare two configurations for U.S. cubicles (cantilevered on a double head rail as observed in the survey with a high and rear neck rail vs. fixed on freestanding posts as recommended) and another recent cubicle type (Euroconfort, cantilevered on head rails, but with a large space between the rails and fixed as recommended), with and without a brisket board. In U.S. cubicles on rails, cows spent more time lying and less time fully standing inside the cubicles than in the other cubicles (percentage of time: lying, 53.9 vs. 51.5; fully standing, 7.3 vs. 8.5); in Euroconfort cubicles, they hit bars more often when getting up than in U.S. Cubicles (percentage of observations: 42.4 vs. 26.4. Without a brisket board, cows lay down more often in a fore position in U.S. cubicles than in Euroconfort ones. Somatic cell counts increased with time in U.S. cubicles on rails and decreased in the other cubicles. It is suggested that the position of the neck rail in U.S. cubicles cantilevered on rails did not leave enough space for the cow to stand inside the cubicle, thereby encouraging the cow to lie down. This could in turn favor udder contamination and/or inflammation. It is concluded that the positioning of the neck rail is of prime importance, that U.S. cubicles should be used with a brisket board and with correct positioning of the neck rail (even when a head rail is used), and that leaving a large space between head rails does not offer an adequate remedial solution for keeping a free head space in front of the cubicle.

A randomized, multicenter, controlled trial using intravenous pulses of methylprednisolone in the initial treatment of simple forms of giant cell arteritis: a one year followup study of 164 patients.

OBJECTIVE: (1) To evaluate the corticosteroid sparing effect of an initial intravenous (i.v.) pulse of methylprednisolone (MP) in the treatment of simple forms of giant cell arteritis (GCA). (2) To analyze corticosteroid response, steroid related side effects, and GCA complications. METHODS: Patients received a 240 mg i.v. pulse of MP followed by 0.7 mg/kg/day oral prednisone (Group 1) or 0.7 mg/kg/day prednisone without an i.v. pulse (Group 2, controls), or a 240 mg i.v. pulse of MP followed by 0.5 mg/kg/day prednisone (Group 3). Corticosteroid dosage was reduced after normalization of 2 biological inflammatory variables to obtain half-dosage after 4 weeks in Groups 1 and 2 and 20 mg/day after 2 weeks in Group 3. Tapering was systematically attempted from the 6th month of treatment. RESULTS: One hundred sixty-four patients were included in the trial (1992-96). Cumulative doses of corticosteroids after one year were identical for all groups (p = 0.39). No significant differences were observed in the time required for normalization of C-reactive protein, corticosteroid resistance (13.5%), and corticosteroid related side effects (39% of patients; p = 0.37). Corticosteroid resistant patients received larger doses and showed a high risk of GCA related complications (p = 0.02). CONCLUSION: MP pulses have no significant longterm, corticosteroid sparing effects in the treatment of simple forms of GCA and should be limited to complicated forms. Moreover, corticosteroid resistance is a real risk factor for GCA complications.

[Rhodococcus equi pulmonary abscess in HIV infection]. / Abcès pulmonaire à Rhodococcus equi lors de l'infection par le VIH.

RE is a well-known Gram positive bacillus which is usually pathogenic in animals. Disease in humans is rare, but incidence has clearly increased with the advent of AIDS. In humans, RE predominantly infect people with impaired cellular immunity so that it is considered an opportunistic agent. Its must common manifestation in immuno-compromised patients is a slowly progressive pneumonia which may cavitate. Even with early diagnostic and optimal and prolonged antibiotic therapy, the mortality of RE, infections remain high (20 to 55%). Problems in clinical and therapic management are illustrated in our two cases of cavitated pneumonia in two AIDS patients.

[Familial porphyria cutanea tarda disclosed by chronic hepatitis C. Apropos of a case]. / Porphyrie cutanée tardive familiale révélée par une hépatite C chronique. A propos d'un cas.

The hepatitis C virus (VHC) is probably the main aetiological factor of severe liver damages associated with the sporadic variety of porphyria cutanea tarda (PCT) in a 28 year-old woman revealed by a chronic C virus infection. Treatment with interferon alpha was delivered.

[Renal angiomyolipoma and pulmonary lymphangiomyomatosis: a non-fortuitous association]. / Angiomyolipome rénal et lymphangiomyomatose pulmonaire: une association non fortuite.

Angiomyolipoma is a rare tumor, frequently associated with tuberous sclerosis, but not observed in its isolated form. Usually, patients with tuberous sclerosis presented with pathognomonic cutaneous and central nervous system lesions. But the thesis of "formes frustes" without typical stigmata was suggested. A case of bilateral and multifocal angiomyolipoma in a young woman without evidence of phacomatosis is reported. The association with a pulmonary lymphangiomatosis make us suspected "a forme fruste" of tuberous sclerosis.

[Chronic herpes resistant to acyclovir in a patient with AIDS]. / Herpés chronique résistant à l'acyclovir chez un sidéen.

INTRODUCTION: The prevalence of mucocutaneous herpetic infection is especially high in patients with the acquired immunodeficiency syndrome (AIDS). In these patients, 8 p. 100 of the chronic or recurrent herpetic lesions are due to a mutant strain. CASE REPORT: A case of very large (900 cm2) genital chronic herpetic infection is reported in a patient with AIDS (stade C3-CDC/WHO 1993). It was characterised by an acyclovir resistant strain which emerged after several anterior treatment with acyclovir. A treatment with foscarnet was administered and clinical improvement was observed as early as the fourth day, with complete reepithelialization 50 days later. DISCUSSION: We discussed essentially the pathogenicity of the herpetic infections due to mutant strains in immunocompromised patients and on the therapeutic modalities. At the present time, foscarnet is the treatment of choice for acyclovir-resistant mucocutaneous herpes simplex.

[Unresectable giant hepatic hemangioma and Kasabach-Merritt syndrome]. / Hémangiome hépatique géant inextirpable et syndrome de Kasabach-Merritt.

The Kasabach-Merritt syndrome was first described in children with cutaneous hemangiomas, but it can exceptionally be associated with visceral hemangiomas, especially in adults. Clotting and fibrinolysis within the hemangioma are thought to cause the coagulopathy observed in the so-called Kasabach-Merritt syndrome. This localised form of intra-vascular coagulation can progress to a secondary increased systemic fibrinolysis with fatal outcome for 20 to 30% of the patients. A transient control of hematologic abnormalities can frequently be obtained with blood product support (platelets, fibrinogen, fresh plasma, cryoprecipitates) and heparinotherapy. But in the adult, the only radical alternative is surgical excision if technically feasible. We reported here the case of a 43 year-old woman with a giant unresectable hepatic hemangioma complicated with a Kasabach-Merritt syndrome.

[Outcome of ruptured intracranial aneurysms treated in accordance with the principle of deferred surgery. 308 consecutive cases over an 11 year period]. / Devenir de l'anévrysme intra-cranien rompu traité selon le principe de l'intervention différée. 308 cas consécutifs sur une période de 11 ans.

The diagnosis of the aneurysm rupture either was assessed at the time of admission, or was assessed after the admission into the surgical department. Most patients were admitted after the first 24 hours following the S.A.H. From the beginning the patients were separated in two groups: 1) The patients unsuitable for planned surgery (grade V--Botterrel, or general contra-indication, such as neoplasm), 2) The patients planned for surgery and called much less than operable patients much greater than (grade I to IV--Botterell, without extra neurological contra-indication). The general management attitude consisted of the delayed surgery according to the neurological status of the patients, and the risk of vaso spasm and ischemia. Thus, in most cases, the surgery was delayed after the 9th day, following S.A.H., and even after the 12th day for anterior communicating aneurysms. The following results were observed: 1) Unoperable patients: (15) The 12 patients in grade V at the time of admission died (with or without emergency surgery). The 3 patients with a general contra-indication have been lost of view. 2) 293 patients were considered for delayed surgery: 16 died before the day of surgery (5,5%). Out of these much less than operable and no operated patients much greater than, 10 died from cerebral ischemia (3,4% of operable patients) and 6 died from hemorrhage recurrence (2%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Lead poisoning revealed by severe encephalopathy : pica does exist in France (author's transl)]. / Intoxication par le plomb révélée par une encéphalopathie sévère. Un cas français de "pica".

Subacute lead encephalopathy due a chronic poisoning was present in a 6 year-old child. Neurologic features (coma, seizures, CSF abnormalities) began after 2 weeks of vomiting, abdominal pain and constipation. Diagnosis was confirmed by studies of porphyrin metabolism. Lead poisoning following pica in childhood has rarely been reported in France. Its pathogenesis, main features, diagnosis and treatment are reviewed.

Platelet volume, density and 5 HT organelles (mepacrine test) in acute leukaemia.

Qualitative platelet parameters (volume, 5 hydroxy-tryptamine (5 HT) organelles studied by the mepacrine test, and density) were evaluated in 31 patients with acute leukaemia: 11 myelomonocytic (AML), 8 lymphoblastic (ALL), 12 granulocytic (AGL). Macrothrombocytosis was observed in most of the cases of AML, was rare in AGL and was never found in ALL. The 5 HT organelles/volume ratio was normal in AGL and ALL but was significantly decreased in AML. In contrast, platelet density distribution was always abnormal whatever the platelet volume and 5 HT organelle concentration. Thus, using simple new methods, convenient even in cases of thrombocytopenia, we demonstrate that qualitative platelet abnormalities are a constant feature in acue leukaemia and that they are more severe in AML.