Gas bubbles in seals, dolphins, and porpoises entangled and drowned at depth in gillnets.

Gas bubbles were found in 15 of 23 gillnet-drowned bycaught harp (Pagophilus groenlandicus), harbor (Phoca vitulina) and gray (Halichoerus grypus) seals, common (Delphinus delphis) and white-sided (Lagenorhyncus acutus) dolphins, and harbor porpoises (Phocaena phocaena) but in only 1 of 41 stranded marine mammals. Cases with minimal scavenging and bloating were chilled as practical and necropsied within 24 to 72 hours of collection. Bubbles were commonly visible grossly and histologically in bycaught cases. Affected tissues included lung, liver, heart, brain, skeletal muscle, gonad, lymph nodes, blood, intestine, pancreas, spleen, and eye. Computed tomography performed on 4 animals also identified gas bubbles in various tissues. Mean +/- SD net lead line depths (m) were 92 +/- 44 and ascent rates (ms(-1)) 0.3 +/- 0.2 for affected animals and 76 +/- 33 and 0.2 +/- 0.1, respectively, for unaffected animals. The relatively good carcass condition of these cases, comparable to 2 stranded cases that showed no gas formation on computed tomography (even after 3 days of refrigeration in one case), along with the histologic absence of bacteria and autolytic changes, indicate that peri- or postmortem phase change of supersaturated blood and tissues is most likely. Studies have suggested that under some circumstances, diving mammals are routinely supersaturated and that these mammals presumably manage gas exchange and decompression anatomically and behaviorally. This study provides a unique illustration of such supersaturated tissues. We suggest that greater attention be paid to the radiology and pathology of bycatch mortality as a possible model to better understand gas bubble disease in marine mammals.

Simplified method of left ventricular thrombectomy.

Postinfarction left ventricular thrombi are at risk for embolization with resultant injury. Surgical removal is recommended especially if they are pedunculated or mobile. We describe an easily applied transatrial method that can allow avoidance of a ventriculotomy.

Population structure of long-finned pilot whales in the North Atlantic: a correlation with sea surface temperature?

The long-finned pilot whale, Globicephala melas, is a social, pelagic odontocete distributed widely in the cold temperate waters of the North Atlantic. Despite genetic, morphometric, physiological and observational studies, it remains unclear whether any population substructure exists. We have used eight highly polymorphic microsatellite loci to analyse samples from four disparate sampling sites: USA East Coast (Cape Cod), West Greenland, the Faeroe Islands and the UK. Our results indicate that substructure does exist, and is particularly pronounced between West Greenland and other sites. The magnitudes of the various pairwise comparisons do not support a simple isolation-by-distance model. Instead, the patterns of genetic differentiation suggest that population isolation occurs between areas of the ocean which differ in sea surface temperature. Such a mechanism is supported by the observation that temperature is a primary factor determining the relative distributions of two short-finned pilot whale (G. macrorhynchus) populations off the Pacific coast of Japan.

Excellence and low case volume: an example of the inapplicability of volume-based credentialing.

BACKGROUND: Health care reform, public disclosure of hospital and surgeon-specific results, plus changes in reimbursement patterns have raised the specter of volume-based credentialing. METHODS: Using The Society of Thoracic Surgeons Cardiac Database, we examined the data for all coronary artery bypass graft-only patients (n = 615) operated on by us from July 1991 to June 1997. RESULTS: The observed mortality was 0.33% and the observed-to-expected ratio was 0.12 (p<0.005). Morbidity was low as well. CONCLUSIONS: Excellent results can be obtained for patients undergoing coronary artery bypass grafting in the presence of both low surgeon and low hospital case volume.

Organochlorines in stranded pilot whales (Globicephala melaena) from the coast of Massachusetts.

Pilot whales strand periodically along the U.S. coast, and these strandings offer an opportunity for the collection of tissues for biomonitoring of contaminant exposure in cetaceans, as well as for specimen archiving. Concentrations of organochlorine (OC) contaminants (e.g., PCB congeners, pesticides, DDTs) were measured in tissue samples from pilot whales that stranded in 1986 and 1990 along the Massachusetts coast. Adult and fetal samples of blubber, liver, brain, and kidney were collected, as well as ovaries from mature female whales. Many of the OCs found in maternal tissues were detected in corresponding fetal tissues indicating maternal transfer of OCs to the fetus. The concentrations of individual OCs in tissues varied considerably among the animals. Statistically significant differences were found between females and males for the concentrations of certain analytes (e.g., SigmaPCBs, p,p'-DDE) and these differences may be partially due to contaminants being transferred by the female whales during gestation and lactation. The concentrations of OCs in different tissues were similar when based on total lipid weight, except for the brain, which contained the lowest lipid-normalized OC concentrations. The low concentrations in brain may be related to the disparate lipid compositions in this tissue as well as the presence of the blood-brain barrier. The availability of data on these archived and biomonitoring samples provides a baseline for future retrospective studies.

Internet developments and their significance for healthcare.

This paper reviews some recent developments in the technology of the Internet, and shows how they may affect the way in which healthcare is provided. Starting with a brief technical history of the Internet, the paper discusses some of the technical developments that have taken place or been proposed in recent years, and speculates on the realities of their adoption within the next five years. The paper also discusses trends in public accessibility to the Internet and the development of Internet services. Finally, the impact of the technological developments on the way in which new healthcare services may be provided is discussed. Our conclusions are that the growth rate in Internet access and the improvements in performance resulting from the new technologies will make the Internet the focus of many new healthcare developments, in particular in the areas of telemedicine and in communication between patient and healthcare professionals. Increasingly, the Internet will be used to convey more 'real-time' information.

Epizootiology of morbillivirus infection in harp, hooded, and ringed seals from the Canadian Arctic and western Atlantic.

Using a virus neutralization technique, we found phocine distemper virus (PDV) antibody in 130 (83% of 157) harp seals (Phoca groenlandica) from the western North Atlantic sampled between 1988 and 1993 inclusive. In contrast, only 44 (24% of 185) hooded seals (Cystophora cristata) had antibodies against PDV even though they were sympatric with harp seals and were sampled over a similar period, from 1989 to 1994 inclusive. Antibodies occurred in 106 (41%) of 259 ringed seals (Phoca hispida); this prevalence was higher than expected given the solitary behavior and territoriality characteristic of this species. Seropositive ringed seals were found at each of seven locations across Arctic Canada from Baffin Bay to Amundsen Gulf at which samples were collected between 1992 and 1994. However, the prevalence of infection was highest where ringed seals are sympatric with harp seals in the eastern Canadian Arctic.

Anti-CD40 ligand antibody treatment prevents the development of lupus-like nephritis in a subset of New Zealand black x New Zealand white mice. Response correlates with the absence of an anti-antibody response.

Systemic lupus erythematosus is characterized by B cell production of pathogenic autoantibodies dependent upon cooperation from CD4+ Th cells. The interaction between CD40 on B cells and CD40 ligand (CD40L) on Th cells is necessary for normal thymus-dependent Ab production. An anti-murine CD40L mAb blocks binding of CD40L to CD40 and prevents primary and secondary immune responses to thymus-dependent Ags. In this study, New Zealand Black x New Zealand White lupus-prone mice treated with this anti-CD40L Ab from ages 4 to 10 mo had reduced anti-DNA autoantibody production and renal disease and significantly prolonged survival compared with control mice. Pathologic examination verified the absence of significant renal damage or immune deposition in responding mice. Mice that responded to treatment did not develop an Ab response to the administered Ab. Long-term survivors mounted a substantial Ab response to keyhole limpet hemocyanin after completion of anti-CD40L Ab treatment, suggesting that some of the immunosuppressive effects of the Ab may be reversible. These results suggest a human form of this Ab may have therapeutic utility in human systemic lupus erythematosus.

Venous structures associated with thermoregulation of phocid seal reproductive organs.

BACKGROUND: Seal reproductive systems are surrounded by thermogenic muscle and insulating blubber, suggesting elevated temperatures at the gonads and uterus. In the limbs of terrestrial mammals, cooled blood returning from superficial veins is mixed proximally with warm blood returning from deep veins. Thus, mixed cool-superficial and warm-deep venous blood from the hind limbs is returned to the central circulation. METHODS: We describe structures observed in salvaged carcasses of harbor (Phoca vitulina), gray (Haliochoerus gryphus), harp (Phoca groendlandica), hooded (Cystophora cristata), and ringed (Phoca hispida) seals. Vessels were identified by dissection of injected and uninjected material. RESULTS: In contrast to terrestrial mammals, phocid seals have anastomoses between the veins of the distal hind limb and the pelvis which allow large volumes of cool blood returning from the skin surface of the flipper to enter the gluteal, pelvic, or pudendo-epigastric veins. This provides a cool-superficial venous return that remains separate from the warm-deep venous return of the femoral veins. The cooled venous blood from the hind flippers supplies venous plexuses lining the inguinal region and the abdominal and pelvic cavities. CONCLUSIONS: Cooled blood may prevent hyperthermic insult to seal reproductive systems.

Epizootiology of morbillivirus infection in North American harbor seals (Phoca vitulina) and gray seals (Halichoerus grypus).

A longitudinal study of morbillivirus infection among harbor (Phoca vitulina) and gray (Halichoerus grypus) seals on the Atlantic coast of North America was carried out between 1980 and 1994. Serology also was carried out on harbor seals from the Pacific northwest coast collected in 1992 and 1993. The prevalence of morbillivirus neutralizing antibodies was significantly (P < 0.0001) higher in gray (73%, n = 296) than in harbor seals (37%, n = 387) from the Atlantic. Titers were significantly (P < 0.0001) higher against phocine distemper (PDV) compared to any other morbillivirus. Antibodies were not detected in serum from Pacific harbor seals. During the winter of 1991 to 1992 an epizootic occurred among harbor seals on the northeast coast of the United States. The event was characterized by an increase in strandings and by a significant (P = 0.001) increase in PDV antibody prevalence to 83% (n = 36) in seals stranded that winter. Morbillivirus lesions and antigen were observed in six animals found stranded from southern Maine to Long Island, New York (USA), between November 1991 and April 1992. In addition, morbillivirus encephalitis was detected in tissues from a harbor seal that stranded in 1988. Enzootic infection appeared to be present in both seal species, although with a different prevalence of disease. We propose that enzootic infection among gray seals is facilitated by population size, high annual recruitment and innate resistance to clinical disease. Infection may be maintained in the smaller harbor seal population through casual contact with gray seals.

Morbillivirus infection in cetaceans of the western Atlantic.

We report serologic evidence of morbillivirus infection in eleven of fifteen species of odontocete cetaceans from the western Atlantic since 1986. Blood samples were obtained both from free-ranging and stranded animals. Virus neutralizing titers were higher against porpoise and dolphin morbilliviruses than against peste des petits ruminants virus, phocine distemper virus or canine distemper virus (CDV). Serum from five species, tested in a heterologous immunoprecipitation assay using radiolabelled CDV, precipitated the nucleocapsid (N) protein. Clinical morbillivirus infection may potentially impact already threatened species such as the harbour porpoise and precipitate mass strandings of socially cohesive odontocetes.

The appearance of H3 influenza viruses in seals.

Surveillance for influenza A virus infection of seals has continued following the association of influenza A virus with epizootics of pneumonia in seals off the New England coast in 1979-1980 and 1982-1983. In January 1991 and January to February 1992, influenza A viruses were isolated from seals that died of pneumonia along the Cape Cod peninsula of Massachusetts. Antigenic characterization identified two H4N6 and three H3N3 viruses. This was the first isolation of H3 influenza viruses from seals, although this subtype is frequently detected in birds, pigs, horses and humans. Haemagglutination inhibition assays of the H3 isolates showed two distinct antigenic reactivity patterns: one more similar to an avian reference virus (A/Duck/Ukraine/1/63) and one more similar to a human virus (A/Aichi/2/68). The haemagglutinin (HA) genes from two of the H3 seal viruses showing different antigenic reactivity (A/Seal/MA/3911/92 and A/Seal/MA/3984/92) were 99.7% identical, with four nucleotide differences accounting for four amino acid differences. Phylogenetic analysis demonstrated that both of these sequences were closely related to the sequence from the avian H3 virus, A/Mallard/New York/6874/78. This indicates that influenza A viruses of apparent avian origin, including the H3 subtype viruses, continue to infect seals.

Genetic impact of an unusual group mortality among humpback whales.

Mass mortalities, due to infectious disease or toxic algal blooms, are known to have severe demographic impacts on marine mammal populations. The genetic impacts of these events, however, have received little attention. To investigate the genetic consequences of an unusual group mortality among humpback whales, we compared the mitochondrial DNA haplotypes of 10 whales poisoned by mackerel contaminated with a dinoflagellate neurotoxin to those of 32 live whales from the same regional population. Two haplotypes that were rare in the reference sample of live whales accounted for eight of the 10 poisoned whales. A randomized test of independence, based on 500 permutations of the data matrix, showed significant differences in the frequencies of haplotypes in the two samples (P < .002). This is the first demonstration that group mortality events in marine mammals can have unpredictable genetic consequences and points to a need to evaluate ecological disasters within the context of the genetic mosaic of natural populations.

Autotransfusion of unwashed mediastinal shed blood fails to decrease banked blood requirements in patients undergoing aortocoronary bypass surgery.

Infusion of unwashed mediastinal shed blood (MSB) is one technique advocated for decreasing use of donor blood in cardiac surgery patients. A commercially available system was prospectively evaluated in 96 consecutive patients. The control group was comprised of 78 consecutive patients. All underwent elective aortocoronary bypass surgery. Student's t-test, chi-square analysis, multivariate analysis, and Fisher's exact test were used where appropriate. There was no decrease in the amount of banked blood required or percentage of patients who received transfusions in the MSB autotransfusion group.

Use of the spiral Salmonella assay to detect the mutagenicity of complex environmental mixtures.

The success demonstrated by the spiral Salmonella assay in a recent study of 20 pure prompted us to examine the effectiveness of this automated bacterial mutagenicity assay for testing complex environmental mixtures. Three sets of combustion emissions were selected for evaluation: automotive diesel exhaust, woodsmoke, and a coal combustion emission. Each sample was tested in the Salmonella mutagenicity assay according to standard protocol (plate incorporation) and spiral assay techniques. In the spiral assay, a specialized plating instrument dispenses the bacteria, test agent, and S9 mix in a spiral pattern onto a minimal agar plate supplemented with histidine and biotin. The components of the assay are administered in such a way that a uniform density of bacteria is exposed to a concentration gradient of the test agent on a single plate. When results are analyzed, a dose-response curve comprised of 13 data points is generated. A comparison of results from the two assays demonstrated the following: 1) Diesel exhaust was generally the most mutagenically potent sample in both assays, followed closely by the coal combustion emission. The woodsmoke sample was only weakly mutagenic in the standard assay but demonstrated higher mutagenic activity in the spiral assay. 2) Samples were more mutagenic on rev/microgram basis in the spiral assay, especially when metabolic activation was added. This disparity presumably was due to differences in the relative amounts of S9 administered across the dose range. 3) The spiral assay required 1/20 the sample mass of the standard assay to test equivalent doses; in addition, for some samples, 50 times more sample mass was required by the standard assay to generate a comparable dose response. 4) Dichloromethane extracts of the complex mixtures could be tested for mutagenicity in the spiral assay, thereby precluding solvent exchange (to dimethylsulfoxide) required by the standard assay for sample/bioassay compatibility.

Anxiety levels and cancer fear in patients admitted for elective operations.

Patients who are to have elective operations project varying degrees of anxiety, and many spontaneously express fear (without basis) that their operation involves a diagnosis of malignancy. To measure total, covert, and overt anxiety objectively, we gave the Institute for Personality and Ability Testing anxiety test to 125 consecutive patients admitted for elective general surgical procedures. A simple survey of cancer fear was also completed. Chi-square and Fisher's exact test were used to compare categoric data, and linear regression and analysis of variance were used where appropriate. Total anxiety scores were in the upper quartile compared to the general population. Scores indicating fear of cancer were elevated in 75% of patients who had no history of or reason to suspect malignancy. Covert anxiety scores correlated with cancer fear scores, and both significantly decreased as age increased (P less than .05). Also, as age increased, the cancer fear scores decreased (P less than .002). Obese patients had higher scores of cancer fear than all other patients (P less than .0001).

Colonoscopic removal of a gallstone obstructing the sigmoid colon.

For the patient with a single gallstone obstructing the colon, this technique offers nonoperative relief of the obstruction, allowing definitive operative therapy to be accomplished at a later time on a more elective basis. The patient should be carefully observed during the interval for intervening recurrent gallstone ileus.