Effect of an extruded pea or rice diet on postprandial insulin and cardiovascular responses in dogs.

Peas are increasing in popularity as a source of carbohydrate, protein and fibre in extruded canine diets. The aim of this study was to test the health effects of two canine diets with identical macronutrient profiles, but containing either yellow field peas or white rice as the carbohydrate source on metabolism, cardiovascular outcomes and adiposity. First, the acute glycemic, insulinemic and cardiovascular responses to the pea- or rice-based diets were determined in normal weight beagles (n = 7 dogs). The glycemic index did not differ between the pea diet (56 ± 12) and rice diet (63 ± 9). Next, obese beagles (n = 9) were fed the yellow field pea diet or white rice diet ad libitum for 12 weeks in a crossover study. Adiposity (measured using computed tomography), metabolic (oral glucose tolerance test, plasma leptin, adiponectin, C-reactive protein) and cardiovascular assessments (echocardiography and blood pressure) were performed before and after each crossover study period. After 12 weeks on each diet, peak insulin (p = 0.05) and area under the curve (AUC) for insulin after a 10 g oral glucose tolerance test (p = 0.05) were lower with the pea than the rice diet. Diet did not show a significant effect on body weight, fat distribution, cardiovascular variables, adiponectin or leptin. In conclusion, a diet containing yellow field peas reduced the postprandial insulin response after glucose challenge in dogs despite continued obesity, indicating improved metabolic health.

Radiographic lymphangiography in the dog using iodized oil.

The objective of this study was to develop a clinically applicable technique to visualize the medial retropharyngeal, superficial cervical, axillary, superficial inguinal and medial iliac lymph nodes on radiographs. Direct and indirect lymphangiographic methods using iodized oil were repeated for a minimum of five times at eight different locations to enhance the various lymph nodes, using 16 healthy research dogs. Direct lymphangiography, although more invasive than indirect lymphangiography, resulted in uniform contrast uptake by an increased number of nodes and increased enhancement of the lymphatic vasculature, and is recommended for imaging the medial iliac and superficial cervical lymph nodes. Side effects were more frequent after indirect lymphangiography (10/20 injection sites) than after direct lymphangiography (3/16 injection sites). The small size of afferent lymphatic vessels did not allow use of direct lymphangiography for the medial retropharyngeal, axillary and superficial inguinal lymph nodes; however, indirect techniques allowed adequate visualization of these nodes.

Effectiveness evaluation of several cattle anthelmintics via the fecal egg count reduction test.

Utilizing groups of cograzed, naturally infected beef-type heifers, three fecal egg count reduction tests were conducted in the later months of 2007 at the University of Arkansas. Each test was 28 days in length consisting of individual animal fecal nematode egg counts and coprocultures. Both original and generic ivermectin injectable formulations were used in two of the tests at 0.2 mg/kg BW, with FECR percentages never exceeding 90% in either test. Oral fenbendazole was evaluated at 5 and 10 mg/kg BW, with FECR%'s exceeding 90% on all occasions, but with a precipitous drop when recently treated animals were treated at the lower dose. Evaluated in one test, injectable moxidectin given at 0.2 mg/kg BW resulted in egg count reductions of 96-92% (days 7 to 28). Also evaluated in one test, albendazole delivered orally at 10 mg/kg BW was 98% and 97% effective at 17 and 28 days post-treatment. For all tests, coprocultures conducted post-treatment contained only Cooperia spp. larvae (benzimidazole use), relatively unmodified percentages of Cooperia spp. and Haemonchus spp. larvae (ivermectin use), and primarily Cooperia spp. larvae with a small percentage of Haemonchus spp. larvae (moxidectin use).

The effects of Donepezil on traumatic brain injury acute rehabilitation outcomes.

PRIMARY OBJECTIVE: To evaluate the effects of administering Donepezil during inpatient rehabilitation for individuals with TBI. RESEARCH DESIGN: Retrospective, age and injury severity matched, mixed between-within subjects analysis. METHODS AND PROCEDURES: Thirty-six patients with moderate-to-severe TBI admitted to acute rehabilitation within 90 days of injury. Main outcome measures included FIM cognitive total scores and rehabilitation lengths of stay. INTERVENTION: Initiation of Donepezil administration beginning at 5 mg daily. Dose titration and continuation based on perceived clinical response. MAIN OUTCOMES AND RESULTS: No differences in cognitive improvement were observed between the Donepezil treatment group and the matched control group. Sub-set analyses suggested that administration of Donepezil early in the rehabilitation stay was significantly related to higher rates of cognitive improvement. CONCLUSIONS: Preliminary evidence suggests that Donepezil administration early in the rehabilitation stay may have advantageous treatment effects. A prospective, randomized, placebo-controlled clinical trial with standard timing, dosage and treatment duration is recommended to further evaluate treatment efficacy.

Case report and rehabilitative management of a complete musculocutaneous nerve injury caused by shoulder dislocation.

Anterior shoulder dislocation can secondarily cause nerve injury and/or rotator cuff tear. An elderly male with a recent shoulder dislocation and multiple medical comorbidities was transferred to a rehabilitation inpatient service in order to maximize his functional status. Physical exam suggested a brachial plexus injury. Electrodiagnostic testing confirmed a complete musculocutaneous and a partial axillary nerve lesion. This specific combination of nerve lesions is a previously unreported complication of anterior shoulder dislocation. Prognosis and treatment are discussed, particularly the use of electrodiagnostic findings to tailor rehabilitation program design.

Evaluation of competence in the interpretation of chest radiographs.

RATIONALE AND OBJECTIVES: The purpose of this study was to determine relative rates of missed diagnoses for radiologists as a measure of competence in interpreting chest radiographs. MATERIALS AND METHODS: Cases involving differing interpretations of chest radiographs were collected from January 1994 through December 1999 by faculty (chest and nonchest radiology specialists) in an academic radiology department. A quarterly peer-review process designated cases months after the fact, and anonymously, as no miss or as class I (nondiagnosable), class II (very difficult diagnosis), class III (should be diagnosed most of time), or class IV (should almost always be diagnosed) missed diagnoses. The rates and classes of missed diagnoses were compared among chest faculty and for the nonchest radiology specialists as a group. RESULTS: Chest radiologists read 184,977 studies, and nonchest radiologists read 300,684 studies. Of these, 243 missed diagnoses were classified (classes I and II, 184 cases; class III, 50; and class IV, nine). No difference was detected in the rate of class III and IV misses among chest faculty, but nonchest faculty had significantly more class III (P = .022) and class IV misses (P = .016). CONCLUSION: Random sampling of differing interpretations can yield a relative rate of missed diagnoses for radiologists. No difference was detected in clinically important misses (ie, classes III and IV) among chest radiologists, but a statistically significantly higher rate of seemingly obvious misdiagnoses was found for nonchest specialty radiologists. Potential biases may have influenced this analysis, including disease prevalence, sampling, clinical factors, observer variability, and truth-in-diagnosis.

Functional outcome for African Americans and Hispanics treated at a traumatic brain injury model systems centre.

OBJECTIVE: To describe the demographics, incidence and functional outcome for African Americans and Hispanics treated at a traumatic brain injury (TBI) model systems centre. DESIGN: Retrospective data analysis of patients admitted to an acute inpatient rehabilitation national TBI model systems centre. SETTING: A tertiary care university medical centre participating in the NIDRR Traumatic Brain Injury Model Systems project. SUBJECTS: Eighty-seven patients with TBI admitted to a Model Systems acute intensive interdisciplinary rehabilitation setting between 1989-1999. Information was extracted from the National TBI Model Systems data base for demographics such as age, race, education, gender, marital and employment status, sponsorship, injury aetiology and severity. OUTCOME MEASURES: Functional outcome was determined using the Functional Independence Measure (FIM), and the Disability Rating Scale (DRS) at the time of admission and discharge. RESULTS: Descriptive statistics were completed using SPSS. African American (94.3%) and Hispanic (5.7%) patients were injured most often as a result of motor vehicle accidents (48.8%). Males comprised 86.2% of this population, which had an average age of 34.5 years (SD = 13.1). On admission, average GCS score was 7.8 (SD = 3.6), average DRS was 13.5 (SD = 5.8), and average FIM total score was 49.8 (SD = 26.5). Average length of unconsciousness was 5.2 days (SD = 27.9), while average length of post-traumatic amnesia was 41.9 days (SD = 59.3). At the time of injury, 78.2% of the patients were not married. The majority of patients (97.7%) had private residences and 88.5% returned to their original home. Most patients had at least a high school education or passed a high school equivalent exam (49.4%) and were employed (70.1%) at the time of injury. Only 7% of the patients had a history of prior TBI. With regard to substance use, only 34.2% of patients reported pre-morbid illicit drug use. However, 50.5% met criteria for heavy or moderate alcohol use rates. Only 35.6% of patients reported a pre-morbid history of arrests, with the average number of arrests equal to 4.5 (SD = 10.2). Within this population, the number of drug or alcohol related arrests was 4.8 (SD = 13.5). CONCLUSIONS: Unmarried African American males, with an average age of 35 years, predominated at this institution. The primary mechanism of injury was motor vehicle accidents. The majority of patients had, at least, a high school education or passed an equivalency exam, were employed at the time of their injury and were discharged to their prior private residence. While half of the patients met criteria for moderate-to-heavy alcohol consumption, only one-third of the patients reported a history of pre-morbid illicit drug use. This descriptive analysis supports the need for further investigation of minority populations that sustain TBI and will enhance the accuracy of implications that minority status may have on functional outcome.

Safety and efficacy of percutaneous coronary interventions performed immediately after diagnostic catheterization in northern new england and comparison with similar procedures performed later.

"Ad hoc" percutaneous coronary interventions (PCIs)-those performed immediately after diagnostic catheterization-have been reported in earlier studies to be safe with a suggestion of higher risk in certain subgroups. Despite increasing use of this strategy, no data are available in recent years with new device technology. We studied use of an ad hoc strategy in a large regional population to determine its use and outcomes compared with staged procedures. A database from the 6 centers performing PCIs in northern New England and 1 center in Massachusetts was analyzed. During 1997, excluding only patients requiring emergency procedures or those with a prior PCI, 4,136 PCIs were performed, 1,748 (42.3%) of these being ad hoc procedures. Patients having ad hoc procedures were less likely to have peripheral vascular disease, renal failure, prior myocardial infarction, or coronary artery bypass surgery, congestive heart failure, or poor left ventricular function, and more likely to have received preprocedural intravenous heparin or nitroglycerin or to have required an urgent procedure. Narrowings treated during ad hoc procedures were less frequently types B and C or in saphenous vein grafts. Adjusted rates of clinical success were not different between ad hoc and non-ad hoc procedures (93.7% vs 93.6%); there was no difference in the incidence of death (0.6% vs 0.5%), emergency (0. 9% vs 0.8%) or any (1.4% vs 0.8%) coronary artery bypass surgery, or myocardial infarction (2.6% vs 2.0%). As currently practiced in our region, ad hoc intervention is used selectively with outcomes similar for ad hoc and non-ad hoc procedures.

The relationship between operator volume and outcomes after percutaneous coronary interventions in high volume hospitals in 1994-1996: the northern New England experience. Northern New England Cardiovascular Disease Study Group.

OBJECTIVES: The purpose of this study was to examine the relationship between annual operator volume and outcomes of percutaneous coronary interventions (PCIs) using contemporaneous data. BACKGROUND: The 1997 American College of Cardiology (ACC)/American Heart Association task force based their recommendation that interventionists perform > or = 75 procedures per year to maintain competency in PCI on data collected largely in the early 1990s. The practice of interventional cardiology has since changed with the availability of new devices and drugs. METHODS: Data were collected from 1994 through 1996 on 15,080 PCIs performed during 14,498 hospitalizations by 47 interventional cardiologists practicing at the five high volume (>600 procedures per hospital per year) hospitals in northern New England and one Massachusetts-based institution that support these procedures. Operators were categorized into terciles based on their annualized volume of procedures. Multivariate regression analysis was used to control for case-mix. In-hospital outcomes included death, emergency coronary artery bypass graft surgery (eCABG), non-emergency CABG (non-eCABG), myocardial infarction (MI), death and clinical success (> or = 1 attempted lesion dilated to < 50% residual stenosis and no death, CABG or MI). RESULTS: Average annual procedure rates varied across terciles from low = 68, middle = 115 and high = 209. After adjusting for case-mix, clinical success rates were comparable across terciles (low, middle and high terciles: 90.9%, 88.8% and 90.7%, Ptrend = 0.237), as were all the adverse outcomes including death (low-risk patients = 0.45%, 0.41%, 0.71%, Ptrend = 0.086; high-risk patients = 5.68%, 5.99%, 7.23%, Ptrend = 0.324), eCABG (1.74%, 2.05%, 1.75%, Ptrend = 0.733) and MI (2.57%, 1.90%, 1.86%, Ptrend = 0.065). CONCLUSIONS: Using current data, there is no significant relationship between operator volumes averaging > or = 68 per year and outcomes at high volume hospitals. Future efforts should be directed at determining the generalizability of these results.

Innervation of the supranasal sac of the puff adder.

BACKGROUND: The supranasal sac is an invagination of the skin between the supranasal and nasal shields of many true vipers. Viperinae behavior suggests that many true vipers hunt by thermal cues. METHODS: The supranasal sacs of two puff adder (Serpentes: Viperinae) were examined with modern histological and neurohistological techniques, including Kiernan's silver stain. RESULTS: There are nerve endings in the supranasal sac of the puff adder that resemble the nerve endings in the labial pits of boas. CONCLUSION: This suggests that the supranasal sac of true vipers is, like the labial pits of boas, a heat detector.

Vocational training for general practice in inner London. Is there a dearth? And if so what's to be done?

OBJECTIVE: To identify the nature and extent of any vocational training deficit within the London initiative zone and investigate the reasons. DESIGN: Collation of statistics and postal questionnaire surveys. SETTING: Thames regions inside and outside the London initiative zone. SUBJECTS: General practice registrars, trainers, principals from non-training practices, and vocational training course organisers. MAIN OUTCOME MEASURES: Trends in numbers of general practice registrars, proportions of trainers, views on current vocational training in inner London. RESULTS: Numbers of general practice registrars fell significantly between 1988 and 1993 within the London initiative zone and in England overall. The number of registrars within the zone fell by more than in the rest of the Thames regions, where the decline was not statistically significant. A lower proportion of principals were approved as trainers within the zone than in the rest of the Thames regions and England overall. In their responses to the survey (88% of inner London registrars responded and 81% of outer Thames registrars) registrars suggested that improving remuneration and personal safety would make training in London more attractive. Trainers and non-trainers (response rates 89% and 66% respectively) also suggested increasing remuneration for trainers together with more protected time for training. CONCLUSIONS: Less vocational training takes place within the London initiative zone than in the rest of the Thames regions and England overall, although there are discrepancies in official statistics. As well as specific recommendations for improving recruitment to vocational training in inner London, measures to tackle inner city deprivation should also remain high on the political agenda.

Influence of low-level cadmium and reduced calcium intake on tissue Cd concentrations and behaviour of American black ducks.

Populations of American black ducks have declined and it has been hypothesized that wetland acidification, which can alter food quality by increasing availability of cadmium and decreasing that of calcium, may have contributed. We tested whether low-level cadmium and reduced calcium intake affect tissue cadmium concentrations and behaviour of captive black ducks. Adults received diets that mimicked cadmium and calcium concentrations in invertebrate prey from acid and from circumneutral wetlands for three spring and summer months in 1991 and 1992. Behaviours were monitored both when birds were fed experimental diets and control (commercial) diets. Cadmium in kidneys and liver differed significantly among groups and low calcium facilitated cadmium uptake. After two breeding seasons, levels of accumulated Cd were not lethal. However, birds that received Cd were significantly more active than control birds. Increased activity may have implications for survival of birds in the wild.

Evaluation of two dosages of oral midazolam as a conscious sedation for physically and neurologically compromised pediatric dental patients.

Physically and neurologically handicapped pediatric dental patients are often a challenge to treat and may require the use of pharmacological agents for behavior modification. The purpose of this study was to investigate the safety, in terms of vital sign changes and complications, and the effectiveness, in terms of behavioral changes, of two dosages of oral midazolam as a conscious sedative agent for this unique population. Participating in this study were 31 patients of Texas Scottish Rite Hospital for Children, who were uncooperative (as rated on the Frankl scale) at a previous dental appointment. The patients, 3-18 years old, were randomly selected to receive one of the two dosage regimens; Group A received 0.3 mg/kg oral midazolam and Group B received 0.5 mg/kg. Physiologic parameters and behavior were recorded throughout the appointment and overall safety and success were determined. Although clinically insignificant, Group A's pulse rates 20 min into treatment were significantly higher than at baseline or treatment start, and oxygen saturations were lower during treatment than at baseline and start of treatment. Intratreatment systolic and diastolic blood pressures and pulse rates of Group B were significantly higher than the baseline figures; however, these changes were not clinically significant. No clinical or postoperative complications were noted for either dosage. The regimen of 0.3 mg/kg of oral midazolam was successful 75% of the time, and the regimen of 0.5 mg/kg of oral midazolam was successful 60% of the time in providing adequate sedation to allow operative treatment to be safely and efficiently performed.(ABSTRACT TRUNCATED AT 250 WORDS)

A collaborative model of a county crisis intervention team: the Lake County experience.

A model is introduced for the classification of crisis intervention and disaster services as being clinic-based, ad hoc, school-oriented, disaster service based and integrative. An example is presented of an integrative-collaborative model that was developed in Lake County, Ohio to cope with situations of suicide, accidental death or natural disaster when they occur in rural areas and small towns. The Community Crisis Intervention Team (CCIT) was developed with characteristics specific to a collaborative model. The distinctive qualities of the CCIT are identified and discussed within the context of a case study of a postvention in a school setting following adolescent suicide.

Ultrasonography of liver. Technique and focal and diffuse disease.

Because of its widespread use and availability, ultrasonography is frequently the first test used to assess patients with focal or diffuse hepatic disease. While ultrasonographic features of hepatic lesions often do not allow for a specific diagnosis, this article demonstrates typical ultrasonographic features of commonly encountered disease entities as an aid to differential diagnosis. Recent advances, including Doppler and intraoperative ultrasonography also are discussed.

Ovarian torsion: sonographic evaluation.

The sonographic and clinical findings of 13 patients with surgically proven ovarian torsion are reported. Sonography demonstrated an abnormal pelvic mass in all patients. The appearance was nonspecific, ranging from solid to cystic, but frequently reflected the commonly associated ovarian pathology present in 69% of patients. The mass was large (mean diameter: 8 cm) and frequently midline (8/13). The clinical findings were variable and nonspecific, leading to a correct preoperative differential diagnosis in only 35% of patients. Preoperative sonography reduced the likelihood of unnecessary appendectomy in patients with ovarian torsion.

Assessment of ultrasonic computed tomography in symptomatic breast patients by discriminant analysis.

From 95 subjects imaged with both speed of sound and attenuation ultrasonic computed tomography (UCT), quantitative analyses are presented on 40 cases where unequivocal correlating clinical diagnoses are available. Using four attenuation and speed of sound parameters from different regions of interest in the breast, a linear discriminator detects cancer with approximately 90% sensitivity and specificity. Increased confidence in the predictive power of this small study is given by a modern test of predictive power (jackknifing) and by the fact that diagnostic discrimination remains as high as 85% when only two parameters are employed--attenuation and speed of sound in the lesion minus those values in the remaining central mammary tissues. Speed of sound images appear particularly useful in older, fatty breasts where pulse echo ultrasound is particularly lacking. While UCT in the form studied here is not likely to receive wide clinical acceptance in the near future, a combined UCT/pulse echo system might find wide clinical utility if it can be sufficiently convenient and inexpensive.

The distinction between femoral artery pseudoaneurysms and other causes of groin masses: value of duplex Doppler sonography.

With the increasing use of percutaneous transfemoral coronary angioplasty in conjunction with thrombolytic as well as anticoagulant therapy, the sonographic evaluation of groin masses, with particular emphasis on differentiating pseudoaneurysms from hematomas and other abnormalities, has become more common. Seventy-three sonograms of the groin in 60 patients (65 different groins) were reviewed retrospectively to determine the accuracy of duplex Doppler sonography in distinguishing femoral artery pseudoaneurysm (a surgical condition) from other causes of groin masses (e.g., hematomas) that are generally treated conservatively. Nineteen cases of pseudoaneurysm, 19 cases of hematoma, and 27 other conditions were studied. Of the 73 sonograms performed, 53 included duplex Doppler studies; one Doppler study was false-negative and two were possibly false-positive. The sensitivity, specificity, and accuracy of duplex Doppler sonography in the detection of femoral artery pseudoaneurysm was 95 +/- 5.8%, 94 +/- 6.4%, and 94 +/- 6.4%, respectively (95% confidence limit). We conclude that duplex Doppler sonography is of value in the differential diagnosis of groin masses.