Decline in human dog-bite cases during a street dog sterilisation programme in Jaipur, India.

Human dog-bite injuries are a major public health problem, particularly where there are large populations of free-roaming or street dogs. Dog bites are also the major source of human rabies infections. There is little information on the means to reduce these injuries. Monthly human animal-bite injury records from January 2003 to June 2011 were obtained from the main government hospital in Jaipur, India. The data were analysed and compared with records of pregnancy in street dogs in Jaipur obtained from a street dog sterilisation programme. Human animal-bite injuries showed a seasonal pattern which followed by approximately 10 weeks the seasonal peak of street dog breeding. The number of human animal bites has declined significantly since 2003. It is concluded that a street dog sterilisation programme can reduce human dog-bite injuries by reducing the maternal protective behaviour of the street dogs, as well as reducing the total size of the roaming dog population.

Control of rabies in Jaipur, India, by the sterilisation and vaccination of neighbourhood dogs.

A programme to sterilise and vaccinate neighbourhood dogs against rabies was established in Jaipur, India. Neighbourhood dogs were captured humanely, sterilised surgically, vaccinated against rabies and, when they had recovered, released where they had been caught. Between November 1994 and December 2002, 24,986 dogs were treated in this way. Direct observational surveys of the local dog population indicated that 65 per cent of the females were sterilised and vaccinated, and that the population declined by 28 per cent. The records of human cases of rabies seen in the main government hospital of the city between January 1992 and December 2002 showed that the number of cases had declined to zero in the programme area but increased in other areas.

Impact of health care reform on the business and practice of ophthalmology.

This study examines the attitudes and opinions of 122 Texas ophthalmologists facing the health care reform movement. It illustrates the commercial practice of ophthalmology today, how practitioners would like it to be, and what they see as the future trends. The study also explores the options and future plans of ophthalmologists for maintaining practice revenues.

Mitral valve repair for mitral regurgitation utilizing intraoperative transesophageal echocardiography--late results.

Ninety consecutive patients underwent mitral valve repair for mitral regurgitation (MR) utilizing intraoperative transesophageal echocardiography (TEE). Fifty-nine males and 31 females between the ages of 31 and 88 with a mean age of 67.9 years were evaluated. Preoperative TEE demonstrated pathology involving the posterior leaflet in 28 patients, anterior leaflet in 21 patients, both leaflets in 19 patients, annular dilatation in 19 patients, and restricted leaflet in three patients. Surgical procedures attempted included quadrangle resection of posterior leaflet pathology (40), Duran "flip over" operation (13), or Goretex suture for anterior leaflet pathology (20), and ring alone for central/ischemic mitral regurgitation (20). TEE immediately following repair showed either no regurgitation or a trace in 78 patients (86%). Time elapsed since repair ranged from one month to 55 months, with a mean of 29 months. Long-range evaluation of mitral valve competence was done by clinical examination and transthoracic or transesophageal echocardiography. Three patients died postoperatively. Fifty-six of 87 patients (64%) had either no or trivial MR within the first year of follow-up. Ring alone for annular dilatation and Goretex suture for anterior leaflet prolapse had the highest incidence of progression of MR. Among the 65 patients followed over one year, 42 (64%) continue to have either none or trivial MR. Three patients had worsening MR requiring mitral valve replacement. Quadrangle resection for posterior leaflet repair and Duran "flip over" operation for anterior leaflet pathology had the highest success rate in long-term follow-up.

The dual impact of "appeal" and "researcher credibility" on mail survey response rate in the context of preventive health care.

Health and fitness centers are becoming increasingly aware of their importance in the realm of preventive health care. Many hospitals have begun to open and run fitness centers, a trend that seems very likely to continue. In a competitive environment, every center would desire to obtain maximum valid customer information at minimum cost, and this paper addresses this issue. The authors investigate the confluence of both appeal and researcher credibility on mail questionnaire response rates from a metropolitan membership of a large fitness center. Personal appeal with high researcher credibility was found to generate significantly higher response rate followed by the hybrid appeal with low researcher credibility.

Phase-shifting holographic interferometry for breast cancer detection.

Using a mild pressure stressing device and a pulsed ruby-laser system, we apply phase-shifted holographic interferometry to the detection of breast cancer. We compare a four-step algorithm and a Carré algorithm for their ability to evaluate the interferograms. The results show the feasibility of holographic interferometry in the detection of anomalies in the human female breast.

Repeat coronary artery bypass: a seven-year experience.

Repeat coronary artery bypass (RCAB) procedures were performed on 323 patients from March 1984 through December 1990. The mean interval between bypass operations was 7.8 years. The operative mortality rate was 4.6%; six of the 15 deaths (40%) occurred in the operating room. Fourteen of the 15 operative deaths (93.3%) were cardiac, all but one of which were due to ventricular failure. Follow-up data for 83 of 91 (91.2%) patients at least five years following RCAB show that 64 (77.1%) are still alive, 39 (60.9%) of whom remain free of cardiac symptoms. Findings in this report, which are notably consistent with those of previous reports, are a significantly higher operative mortality rate and higher risk of death in the operating room in patients undergoing repeat bypass compared with those having initial coronary artery bypass. The challenge of reducing the mortality risk following coronary reoperation is discussed in this report.

Intraoperative transesophageal echocardiography--an indispensable tool in valve reconstruction and congenital anomalies.

Transesophageal echocardiography (TEE) with color flow mapping has become an excellent tool for evaluating valve reconstruction and correction of congenital anomalies intraoperatively. From February 1990 to September 1990 we have utilized TEE intraoperatively in 14 consecutive patients. Their ages ranged from 25 to 77 years, with a mean age of 58.7 years. There were eight males and six females. Twenty-one pathological entities were identified intraoperatively: mitral regurgitation due to posterior leaflet pathology in four; anterior leaflet pathology in four; annular dilatation in two; left to right shunt at the atrial level in five (two with partial anomalous pulmonary venous drainage); aortic regurgitation in two; and one patient each with ostium primum septal defect, Ebstein's anomaly, hypertrophic obstructive cardiomyopathy (HOC), and aortic stenosis. Based on intraoperative TEE findings, corrective procedures included quadrangle resection posterior leaflet with Carpentier ring in four, chordal shortening and chordal transfer anterior leaflet in four, flexible Duran ring for annular dilatation in two, closure of all atrial septal defects (ASD) with pericardial patch in secundum and sinus venosis type (ligation of small anomalous vein in one), and Dacron patch in primum type, myomectomy for HOC and reconstruction of the tricuspid annulus with Duran ring in Ebstein's anomaly. Two patients with associated coronary artery disease had coronary bypass grafting done. Following mitral valve repair TEE demonstrated trivial to no mitral regurgitation in eight (seven with repair) and mild regurgitation in one patient. All patients with closure of the ASD had an intact septum. The gradient in HOC was reduced significantly and there was satisfactory anatomical reattachment of the tricuspid annulus in Ebstein's anomaly.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary artery bypass plus mitral valve replacement. A five-year study.

Fifty-two patients with a mean age of 67.6 years underwent coronary artery bypass plus mitral valve replacement from 2 April 1984, through 6 February 1989. All but four of these 25 males and 27 females were in the New York Heart Association Functional Classes III and IV, with presenting symptoms of angina and/or dyspnea. Twenty-four patients (44.2%) presented with acute myocardial infarctions, and eleven patients (21.2%) had a past history of rheumatic fever or rheumatic heart disease. Forty-five patients (86.5%) had a diagnosis of coronary artery disease plus mitral regurgitation. Treatment included a mean of 2.3 bypass grafts per patient plus mitral valve replacement with Carpentier-Edwards (41), St. Jude (10), and Bjork-Shiley (1) prostheses. The four operative deaths (7.7%) were attributed to congestive heart failure (1), mediastinal bleeding (1), mediastinitis (1), and stroke (1). There were eight late cardiac deaths (16.7%) and six late noncardiac deaths (12.5%), a mean of 16.6 and 18.9 months postoperatively, respectively. Thirty-four patients have survived from 10 to 65 (mean 33.7) months postoperatively with a mean New York Heart Association Functional Class 1.6. Follow-up determination of patients' attitudes toward their surgery was ascertained in 28 of the 34 survivors, and 26 (92.8%) patients indicated that they were pleased with their surgery. These results compare favorably with data reported in the recent literature. In addition, the study shows that patients requiring supportive treatment in a critical care unit preoperatively had the same operative mortality but more postoperative complications and a longer mean hospital stay than the equal number of patients who were not in a critical care unit preoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Experimental colonic anastomosis in bovines--and angiographic study.

4 different methods of colonic anastomosis, single and double layer inversion and eversion, were performed on cowcalves. Hypervascularization of neovascularized arterioles at the cut ends of colon were visualized on the 7th day by all techniques. The arterioles, later one, tended to reorganise towards normalcy. Inversion technique showed better vascularization at the anastomotic site, and the vascular pattern was nearly normal on the 14th and 28th days from surgery. Eversion technique did not exhibit satisfactory revascularization of the anastomotic site on the 7th day of study. A radiopaque area, davoid of arterioles, was noted on the 14th and 28th days from surgery.

Synchronous cancers of the colon and rectum: report of eight cases.

This study reviews eight patients collected over a period of 3 yr with synchronous primary adenocarcinomas with special emphasis on presentation of illness, diagnosis, location of tumors, and their association with benign polyps. All of the synchronous carcinomas in this study were located in different surgical segments and all associated benign polyps were located in the same surgical segments. Workup included colonoscopy followed by completion of colon examination by barium enema. All patients underwent surgical resection of their tumors. It is therefore concluded that the incidence their tumors. It is therefore concluded that the incidence of synchronous tumors of the large colon is high enough to warrant total colon examination either by colonoscopy or barium enema.

Mitral valve prolapse and ruptured chordae tendineae.

To determine the causes of ruptured chordae tendineae and a suspected etiologic role for mitral valve prolapse (MVP), the mitral valve in 25 consecutive and surgically proved cases of chordal rupture were examined. The diagnosis of MVP was made on the basis of redundancy and marked hooding of the mitral leaflets and on histologic changes. MVP was the underlying morphologic abnormality in 23 patients, only 1 of whom had infective endocarditis that was responsible for the rupture. Thus MVP was the only underlying morphologic abnormality in 22 of 25 patients (88%). Another finding in this study was the demonstration of auscultatory and angiographic or echocardiographic evidence of MVP in 4 patients, aged 4 to 11 years (mean 7), before chordal rupture; no patient had had endocarditis. The morphologic and historical evidence would indicate that MVP is probably the most common cause of so-called spontaneous chordal rupture.

Should the greater saphenous vein be preserved in patients requiring arterial outflow reconstruction in the lower extremity?

Two patient groups were studied to determine the need to preserve the greater saphenous vein during femoral outflow reconstruction for later aortocoronary bypass procedures. First, 74 patients were followed to the time of death or to a minimum of 5 years after femoral outflow reconstruction was performed. Only four patients (5.4%) underwent subsequent aortocoronary bypass. The previous outflow procedures had no adverse effect on the quality of aortocoronary conduit. Risk factors were analyzed to help predict the incidence of later coronary revascularization after femoral outflow reconstruction was performed. The second group that was analyzed included 500 nearly consecutive patients who underwent aortocoronary bypass. In 15 of these patients (3%), there was inadequate saphenous vein for conduit use. In no case was the inadequacy of saphenous vein due to its previous use as outflow conduit in the leg. Only seven patients (1.4%) had had an outflow reconstruction prior to aortocoronary bypass. In conclusion, continued use of adequate greater saphenous vein as femoral outflow conduit is justified despite the high incidence of coronary artery disease in these patients.

Effects of limb tourniquet ischemia on local and systemic acid-base and blood gases of cattle.

Effects of forelimb tourniquet ischemia of 90 minute duration were investigated in six bulls aged two to three years. Studies were also conducted up to 150 minutes after release of the tourniquet. Parameters investigated were pH, PCO2, PO2, oxygen saturation and HCO3. In systemic circulation no variations in different parameters were observed during 90 minutes of ischemia. However, significant increase in arterial and venous pH were observed after 30 and 45 minutes of the release of tourniquet, respectively. These increases were accompanied by an increase in HCO3. In the affected limb, ischemia resulted in severe acidosis with a significant increase in PCO2 and a nonsignificant decrease of HCO3. There was a significant fall in PO2 and oxygen saturation. After release of the tourniquet, limb venous pH increased significantly due to a significant fall in PCO2 and a nonsignificant increase in HCO3. A significant increase in the limb venous PO2 and oxygen saturation post tourniquet was observed up to the end of the experiments. There was evidence of very poor oxygen exchange and utilization up to 150 minutes after release of the tourniquet. These results demonstrated that tourniquet ischemia of 90 minutes duration of the limb of cattle may not be safe.