Occurrence of infectious upper respiratory tract disease and response to vaccination in horses on six sentinel premises in northern Colorado.

REASONS FOR PERFORMING STUDY: Horses vaccinated against common agents of infectious upper respiratory disease (IURD) may not have detectable serum antibody and may not be protected from clinical disease. OBJECTIVES: The objectives of this study were to 1) investigate the serological response of horses to vaccination against influenza virus (H3N8 and H7N7) and equine herpesviruses (EHV) in a field setting and 2) evaluate associations among vaccination status, serum antibody concentrations, and occurrences of IURD in monitored horses. METHODS: In this study, horses on 6 Colorado premises were vaccinated parenterally against influenza virus and EHV, and serological response evaluated. Horses were monitored, and biological samples collected from individuals with clinical IURD and control horses. RESULTS: Of 173 horses, 61 (35.3%), 21 (12.1%) and 4 (2.3%) seroconverted in response to vaccination against EHV, influenza virus H7N7 and influenza virus H3N8, respectively. CONCLUSIONS: Outbreaks of IURD in study horses were associated with influenza virus H3N8 and Streptococcus equi infection, and serological response to vaccination with conventional products was poor. POTENTIAL RELEVANCE: These results confirm that horses may not respond with detectable serological responses to conventional vaccination against common respiratory viruses and, therefore, suggest that alternate methods of protecting horses against common respiratory viruses should be sought.

Factor-based prototypes of the Millon Adolescent Clinical Inventory in adolescents referred for residential treatment.

Although well received by the clinical community, there have been few published reports on the use of the Millon Adolescent Clinical Inventory (MACI). There have been no published studies describing use of the MACI with a residential treatment population. In addition, there have been no published reports investigating the factor structure of the MACI. A principal components factor analysis was performed for all MACI scales and sex for 251 adolescents referred to a residential treatment facility. Five factors were found accounting for 77.4% of the variance. Factor-based prototypes were generated from these results: Factor 1 defines a prototype for Defiant Externalizers, Factor 2 for Intrapunitive Ambivalent Types, Factor 3 for Inadequate Avoidants, Factor 4 for Self-Deprecating Depressives, and Factor 5 for Reactive Abused Types. Prototype descriptions and clinical vignettes are included for each of the 5 factor-based prototypes. These results are consistent with our clinical experience with this population. Prototype analysis may offer a powerful way of enhancing the utility of the MACI in clinical settings.

A sketch of man's efforts to mend his troubled mind.

People have sought comfort for their miseries and a cure for their troubles since prehistoric times. View the highlights of the story of psychiatry in this lightning tour of psychiatric history.

Methyl prednisolone in double-lumen gel-saline submuscular mammary prostheses: a double-blind, prospective, controlled clinical trial.

At the time of immediate breast reconstruction with submuscular implants, 76 consecutive patients (89 breasts) were randomized into two groups. One received a gel-saline, double-lumen implant with 40 cc of saline added to the outer lumen, while the other received the same implant plus 40 cc of saline and 16 mg methyl prednisolone (40 mg%). Patients were followed for a minimum of 3 years. The groups, which were matched for patient age and implant size, were evaluated at 3, 12, 24, and 36 months for capsular contracture, steroid atrophy, and other complications. With completion of the double-blind study, the patients with submuscular gel-saline implants with only saline added had an overall capsular contracture rate of 38 percent at 3 months, 38 percent at 12 months, and 44 percent at 24 and 36 months. Those with methyl prednisolone had an overall capsular contracture rate of 14 percent at 3 months, and this remained unchanged through the end of the study. The rates of all other complications were comparable. Methyl prednisolone in a dose of 16 mg in 40 cc saline (concentration 40 mg%), when used in the outer lumen of a double-lumen gel-saline implant in a submuscular pocket, is both safe and efficacious in reducing the risk of capsular contracture for a minimum of 3 years in patients undergoing immediate breast reconstruction with submuscular mammary implants.

Variations on the temporoparietal fascial flap.

An improved understanding of the vascular supply of the layers of the temporal fossa has increased the potential of this region for new and ingenious reconstructive techniques. Separate and independently vascularized layers of this region include hair-bearing scalp, glabrous skin, tempororoparietal fascia (and galea aponeurotica), temporalis muscle and fascia, and pericranium. Island flaps of glabrous skin and scalp provided esthetically appropriate tissue to cover a variety of defects. The malleable bulk of the subcutaneous fascial layers were combined with skin grafts to restore thin lining, and used as a vascularized bed for cartilage grafts in otherwise unsatisfactory recipient sites. Illustrative cases from our 5-year clinical experience are presented to demonstrate various combinations of the temporoparietal fascial pedicle with tissues from the temporal region to reconstruct the eyebrows, eyelids, orbits, cheeks, and lips.

The changing face of beauty.

Beautiful faces, like clothing and body conformation, go in and out of fashion. Yet, certain women in every era are considered truly beautiful. Who, then, sets standards of facial beauty and how are women chosen as representative of an ideal? Identifying great beauties is easier than explaining why they are chosen, but answers to these elusive questions are suggested in art, literature, and a review of past events.

Art, love, and facial beauty.

The author discusses female facial beauty through reference to works of art by Praxiteles, Rubens, and Rossetti.

A new twist to the nasolabial flap for reconstruction of lateral alar defects.

The nasolabial flap remains the favored technique for alar and lateral nasal reconstruction. Results with currently popular techniques tend to be inartistic and aesthetically disappointing. Improved results can be achieved, however, by a technique using a medially based nasolabial turnover flap for lining with a distal extension providing the cover. Reconstruction of the ala begins by designing a nasolabial flap with its base as close as possible to the site of the proposed ala. The flap is incised to the required margins, carrying 2 to 3 mm of underlying fat; then, hinged on its base, the flap is flipped over medially like the page of a book. As the proximal flap is sutured to the lining side of the defect, the distal flap gracefully twists 90 degrees and is then folded on itself to form the external surface of the ala. The donor site is closed primarily. With this procedure, a natural-appearing and appropriately positioned ala may be reconstructed in one step, although a second procedure may be helpful to sculpture the margin or precisely position the alar base.

Costal cartilage sculpturing as an adjunct to augmentation mammaplasty.

Costal cartilage irregularities are a major component of most congenital thoracic-wall deformities. A significant number of patients with these cartilage irregularities may either refuse major reconstruction or in fact have disorders of insufficient magnitude to justify such endeavors. In patients undergoing augmentation mammaplasty, recontouring or sculpturing of these abnormal costal cartilages may correct or improve the underlying chest-wall deformity and thus enhance the final aesthetic result. This method has had application in mild to moderate asymmetrical cases of both pectus excavatum and pectus carinatum, thoracic hypoplasia (Poland's syndrome), isolated cartilage deformities, and spinal scoliosis. In our hands, the combination of cartilage sculpturing with submuscular augmentation mammaplasty is performed as an outpatient local anesthetic procedure requiring not more than 90 minutes.

Henri-Francois Secretan.

Henri-Francois Secretan was a Swiss physician. He described hard edema of the hand in 1901 in a report that went unnoticed until interest in this condition revived in recent decades.

Cancer of the larynx: current concepts of diagnosis and treatment.

Cancer of the larynx is a potentially fatal disease. Familiarity with current treatment, however, makes it potentially curable. This article discusses the available therapeutic options and their consequences.

Burns in art.

Burn care and burned people are probably the least likely candidates as subjects of fine art. To disprove this notion, three paintings are offered as examples of artistic treatment of an unlikely issue.