Lameness associated with tarsal haemarthrosis as the sole clinical sign of idiopathic immune-mediated thrombocytopenia in a dog.

A four-year-old, male Cocker Spaniel was presented for investigation of pelvic limb stiffness. There was palpable effusion of both tarsi, and analysis of synovial fluid from these joints indicated previous haemorrhage. After further investigation a diagnosis of idiopathic immune-mediated thrombocytopenia was made. The dog responded to treatment with prednisolone and azathioprine. To the authors' knowledge, this is the first reported case of confirmed haemarthrosis as the sole presenting clinical sign for canine idiopathic immune-mediated thrombocytopenia.

Central diabetes insipidus: a rare perioperative cause of severe hypernatraemia.

In this case report we describe the management of severe hypernatraemia following inadvertent water restriction. A 21-year-old woman with no reported medical history presented on transfer from an outside hospital with a complex volar upper extremity injury. Management both operatively and postoperatively involved a prolonged period of fasting which limited her access to drinking water Collateral history revealed that she had previously drunk copious amounts of water during the course of any given day and this had served to alleviate the dramatic symptoms of hypernatraemia that were rapidly manifest when her normal intake was curtailed. We outline the fluid management, administration of desmopressin and her subsequent recovery. A literature review of the management of central diabetes insipidus is also covered.

Impact of managed waiting for coronary artery bypass graft surgery on patients' perceived quality of life.

BACKGROUND: Current demand for CABG surgery remains high, often exceeds available resources, and has led to the development of managed waiting lists. This study was designed to determine how being placed on a managed waiting list for > 6 weeks for CABG surgery affected patients' perceived quality of life in a Canadian center. METHODS AND RESULTS: Telephone interviews were carried out in the setting of a large urban hospital in northern Alberta. All participants were identified from 3 waiting lists of adult patients waiting for open heart surgery. A master list of patient statements was compiled to formulate the 47-item Waiting List Impact Questionnaire (WLIQ). A total of 102 patients completed the WLIQ by telephone interview. Patients (87.5%) indicated that their quality of life had deteriorated since being placed on the waiting list. None of the patients perceived an improvement in their quality of life. Frequency data for the WLIQ provided a broad, multidimensional perspective of the experience of waiting for CABG surgery and its impact on perceived quality of life. Negative impact was found in each of 5 main themes: employment and income, physical stress, social support, frustration, and quality of life. CONCLUSIONS: This study indicates that patients perceived a negative impact on their quality of life after being placed on a managed waiting list for CABG surgery. In the allocation of healthcare resources, attention should be paid to the impact of waiting on patients' physical well-being as well as on quality of life.

The evolution of the concept of brain death.

The definition of death has taken many forms throughout history. Because of advances in critical care and developments in transplantation, a new definition of death has evolved over the past 30 years. The first accounts of brain death were published in 1959, in relative obscurity. They were only considered to be of academic interest. In the mid-1960s, advances in transplantation and the need for viable organs started debate about the use of "brain-dead" patients as organ donors. Conceptual advances by the ad hoc committee of the Harvard medical school and the use of angiography and the electroencephalogram both advanced and confused the issue. Acceptance by the medical community remained divided. During the 1970s, brain-stem death was proposed as the true definition of death by pioneers in the United States and Britain. In the 1980s, the clinical diagnosis of brain-stem death was officially accepted and many of the controversies subsided.

Pharmacokinetic analysis of ampicillin concentration in neonates: comparison of two pharmacokinetic models and of two numerical methods.

Ampicillin blood levels after i.m. injection were analysed according to a one and a two-compartment pharmacokinetic model. The two-compartment model gave no substantially better fit to the data than a one-compartment model. To fit the one-compartment model two computer programs based on different numerical methods, were tested. The BMD program gave satisfactory results in all cases.