Recommendations for a standardised educational program in robot assisted gynaecological surgery: Consensus from the Society of European Robotic Gynaecological Surgery (SERGS).

BACKGROUND: The Society of European Robotic Gynaecological Surgery (SERGS) aims at developing a European consensus on core components of a curriculum for training and assessment in robot assisted gynaecological surgery. METHODS: A Delphi process was initiated among a panel of 12 experts in robot assisted surgery invited through the SERGS. An online questionnaire survey was based on a literature search for standards in education in gynaecological robot assisted surgery. The survey was performed in three consecutive rounds to reach optimal consensus. The results of this survey were discussed by the panel and led to consensus recommendations on 39 issues, adhering to general principles of medical education. RESULTS: On review there appeared to be no accredited training programs in Europe, and few in the USA. Recommendations for requirements of training centres, educational tools and assessment of proficiency varied widely. Stepwise and structured training together with validated assessment based on competencies rather than on volume emerged as prerequisites for adequate and safe learning. An appropriate educational environment and tools for training were defined. Although certification should be competence based, the panel recommended additional volume based criteria for both accreditation of training centres and certification of individual surgeons. CONCLUSIONS: Consensus was reached on minimum criteria for training in robot assisted gynaecological surgery. To transfer results into clinical practice, experts recommended a curriculum and guidelines that have now been endorsed by SERGS to be used to establish training programmes for robot assisted surgery.

[Notifiable animal diseases diagnosed at the Institute of Veterinary Pathology of the University of Zurich between 1988 and 2004]. / Meldepflichtige Tierseuchen diagnostiziert am Institut für Veterinärpathologie der Universität Zürich zwischen 1988 und 2004.

One of the essential tasks of veterinary pathology is the gross and microscopic examination of animals post mortem. Frequently requests are made for the cause of disease or death in the absence of a precise history or an otherwise specific assignment e.g. whether a notifiable disease is involved. The general examination is supplemented by a spectrum of additional examinations depending on the case whereas attempts are made to keep the costs within limits and to answer the client's request with justifiable effort. 36,365 necropsy cases and 9192 organs submitted between 1988 and 2004 were analysed to give indications on the number and type of notifiable diseases that were diagnosed in the course of routine diagnostic procedures. Notifiable animal diseases were discovered in 2918 cases (6.4% of all investigated cases) namely 2426 farm animals (9.1% of all farm animals) and 492 animals of other species (2.6% of all other animal species). These data illustrate the considerable value of pathological-anatomical examinations and compliment the figures from other databases.

Impact of restricting fluoroquinolone prescription on bacterial resistance in an intensive care unit.

The purpose of this study was to assess the effect of reducing prescription of fluoroquinolones in an intensive care unit (ICU) upon bacterial resistance, particularly as regards Pseudomonas aeruginosa. For six months between January 2001 and June 2001, administration of fluoroquinolones was kept to a minimum. A bacteriological screening of patients was performed to assess the incidence of fluoroquinolone-resistant bacteria. There was a 75.8% restriction in prescriptions of fluoroquinolones. There was no significant change in bacterial ecology between the periods preceding (12 months) and following (12 months) restriction. There was a significant recovery of sensitivity of P. aeruginosa to ciprofloxacin (P

Phase II study of a radiotherapy/etoposide combination for patients with newly malignant gliomas.

PURPOSE: Etoposide, a semisynthetic derivative of podophyllotoxine, is a topoisomerase II inhibitor. This drug is currently used in several types of human cancer. The aim of this study was to evaluate the efficacity and tolerance of a near-concurrent association of radiotherapy and etoposide for newly malignant gliomas. METHODS: From May 1995 to December 1996, 30 malignant glioma patients were included in this phase II study; 16 patients underwent surgical tumor resection, and a stereotactic biopsy was performed in 14 patients. Standard cranial irradiation and six courses of etoposide (100 mg/m2, x days 1-3) were administered. The first course of etoposide was administered on days 1-3 of radiotherapy and was resumed in the week following the end of radiotherapy. Treatment was consolidated by further courses of etoposide every 4 weeks. RESULTS: Only 26 patients could be evaluated for the purpose of our study. The median age was 60.1 years, and the median Karnofsky performance score (KPS) was 80.2. The rate of objective response for evaluable patients was 34.6%, and four complete responses (CR) and five partial responses (PR) were noted. The median survival (MST) was 12 months, and the average overall survival was 12.5 months. Hematological toxicity was mild, and grade 3 or 4 neutropenia (white blood cell count < 1500/ml) was noted in three patients, without any sepsis or bleeding. CONCLUSIONS: The results obtained in this study are comparable to the best reported results on the combination of radiotherapy and nitrosoureas. The near-concurrent combination of radiotherapy and etoposide seems to be effective and well tolerated in the treatment of newly malignant gliomas.

Effects of continuous environmental illumination on the albino rat hypothalamo-neurohypophysial system.

Continuous environmental illumination or constant light (LL) exposure causes a suppression of daily water intake, and long-term exposure of greater than 19 days produces a hypertrophy of magnocellular neuroendocrine cells (MNCs) in the hypothalamus. These findings led Glantz to hypothesize that LL increases the secretion of vasopressin (VP). We wanted to determine whether LL could trigger morphological changes within the hypothalamo-neurohypophysial system (HNS) seen with other manipulations that result in enhanced hormone release. The posterior pituitary of male albino rats that were exposed to LL for 24 or 48 h were examined ultrastructurally for evidence of enhanced hormone release. In addition, water intake, plasma VP levels, and MNC size within the supraoptic nucleus (SON) were measured. After LL exposure, the posterior pituitary morphology was different, suggesting enhanced hormone release. LL exposure did not affect plasma VP or the size of SON MNCs, but did suppress drinking behavior. These data show that posterior pituitary morphology is affected rapidly by LL exposure. The HNS response to LL exposure may consist of changes within the first 24 h of LL found within the posterior pituitary followed later by hypertrophy of the SON MNCs.

Preliminary study of the deposition of aerosol in the maxillary sinuses using a plastinated model.

In spite of the widespread use of aerosols in respiratory diseases, very few studies have been performed in the field of ear, nose, and throat (ENT) disorders. The conditions for penetration of aerosols inside the sinus cavities are thus still not understood fully. The aim of this study was to investigate the penetration of aerosols inside maxillary sinuses in vitro, using plastinated models. Three plastinated specimens of the nose and sinuses were made from three different corpses. These specimens were validated by CT scans and were used to study deposition of aerosol in the maxillary sinuses. We performed scintigraphic images of the models in above, face, and profile views using a technetium (99mTc)-labelled solution to show aerosol deposition. We also counted the radioactivity deposited on gauze compresses placed inside the maxillary sinuses. In addition, we constructed a measuring unit with miniature humidity sensors placed inside the sinuses. We recorded the changes in relative humidity observed during nebulization. Results from these studies showed that scintigraphic images of the specimen, whatever the incidence of the views, were not accurate enough to differentiate the aerosol deposition in the maxillary sinuses from that in the nasal cavity. Using indirect counting on gauze compresses made possible the quantification of local aerosol deposition, and we found that aerosols entered into the sinuses. This confirmed that aerosols could reach the middle meatus, which is the main area for sinusitis disorders. The increased activity compared to background varied from 17 to 127%. The humidity sensors recorded changes in relative humidity during the nebulization. These humidity changes fitted a nonlinear model represented by the equation: y = b0 (1 - e(-b1t)), where b0 is the plateau and b1 is the speed to reach the plateau. These techniques may be useful in the future for in vitro characterization of aerosol penetration into the maxillary sinuses.

The federal system of Veterinary Services in Switzerland.

The Veterinary Service is described in the context of the federal state system in Switzerland. The Federal Veterinary Office (FVO) plays a leading role in this Service. Apart from its responsibility for legislation, the most important task of the FVO is the dissemination of information throughout Switzerland. The responsibility for ensuring that the laws are implemented lies with the 26 cantons. Veterinary public health is a key function of the Veterinary Service, where the core focus is on the implementation of the 'stable to table' concept. Animal protection is also an important function. A certified Veterinary Service requires a high-quality system based on professionalism, objectivity and evaluation. In this paper, the various strengths and weaknesses of the system in Switzerland are discussed and the disadvantages are analysed in depth.

Mismatch between radionuclide and contrast angiography in the assessment of the perfusion of a transplanted kidney.

When early complications occur after a kidney transplant, radionuclide angiography may be useful in determining a possible vascular origin. The authors describe the case of a patient with anuria continuing 24 hours after transplantation. Radionuclide angiography showed a defect at the site of the renal graft, suggestive of arterial or venous thrombosis. Contrast angiography was performed immediately but showed no vascular abnormality; neither did radionuclide angiography performed the next day. The authors concluded that a spasm at the site of the renal artery anastomosis, overcome by contrast angiography, could explain this phenomenon.

Treatment of urinary incontinence in dogs by endoscopic injection of Teflon.

Twenty-two dogs with urethral sphincter incompetence, nonresponsive to phenylpropanolamine administration, were treated by urethral submucosal injection of Teflon. Urinary continence was achieved in all dogs for at least 2 months. Urinary incontinence recurred in 14 dogs (64%) and was controlled by a second Teflon injection in 11 of 12 dogs (92%). Minor complications included transient stranguria, with or without hematuria, after 4 of 35 injection procedures. One dog had temporary partial urethral obstruction after treatment.

Clinical, haematological and biochemical findings in milk-fed calves with chronic indigestion.

The principal clinical signs in 59 milk-fed calves with chronic indigestion were general malaise and depression, poor appetite, poor body condition, dehydration, a dull and scaly hair coat, alopecia and clay-like faeces. All the calves had metabolic acidosis, which was associated with an inability to stand up in more than half of them. There were significant differences in the severity of acidosis between the calves that could stand and those that could not. Other signs in some of the calves were dehydration, leucocytosis, and increased activities of liver enzymes.

Acid-base disorders in milk-fed calves with chronic indigestion.

Acid-base disorders were investigated in 50 calves with chronic indigestion and metabolic acidosis. In the calves that were unable to stand up, the acidosis was significantly more severe than in the calves that could stand up. The anion gap and four different components of the base excess were calculated by the method described by Fencl. The anion gap was high in more than half of the calves, and it was significantly associated with the base excess due to unidentified anions. However, in seven of the calves, the excess of unidentified anions would not have been detected without the calculations, which made it possible to measure the effect of sodium, chloride, plasma protein and unidentified anions on the acid-base balance. Twenty-four of the calves had a combination of hyperchloraemic and high anion gap metabolic acidosis. Changes in sodium and plasma protein concentrations had a minor impact on the calves' acid-base status.

Evaluation of biochemical methods for estimating the sodium intake of dairy cows.

Samples of blood and urine were taken from 334 dairy cows in 29 herds, and the concentrations of sodium and potassium were measured in the serum and urine. The herds were split into five groups according to the amount of supplementary salt they were given: three groups given 10 to 20, 30 to 50 or 70 to 100 g salt per day, and two groups fed an ad libitum supply, given either in bowls or in the form of salt blocks, which were replaced either regularly or irregularly. The groups which received 70 to 100 g of salt daily or were supplied regularly ad libitum had significantly higher urinary sodium concentrations than the other groups. The group receiving 10 to 20 g a day had a significantly higher ratio of potassium:sodium in their urine than all the other groups, in which the ratio decreased as the level of supplementary salt increased. There were wider differences between the groups in terms of the urinary potassium:sodium ratio than in terms of the urinary sodium concentration but less variability within each group.

Uterine serosal inclusion cysts in a bitch.

A six-year-old, pluriparous German shepherd dog bitch was presented with an abnormal vaginal discharge of several weeks' duration. Clinical signs and radiographic and ultrasonographic findings supported an initial diagnosis of segmental cystic endometrial hyperplasia, and ovariohysterectomy was performed. Macroscopically, the uterus appeared normal except for one large and several smaller cysts attached to its antimesometrial side. These cysts were restricted to a small area of the left uterine horn. The histological diagnosis was serosal inclusion cysts. The clinical findings, gross pathology and histopathology are described and discussed.

Treatment of urinary incontinence in bitches by endoscopic injection of glutaraldehyde cross-linked collagen.

Thirty-two spayed bitches with urinary incontinence due to urethral sphincter incompetence, non-responsive to phenylpropanolamine administration, were treated by urethral submucosal injection of glutaraldehyde cross-linked collagen. Urinary incontinence resolved after a single injection in 19 of the bitches. Additional medication with phenylpropanolamine was necessary in five of these dogs, however. Of the 13 bitches that remained incontinent, the injections were repeated in nine. This resulted in a return to continence in five dogs, although two of these required additional medication for complete continence. The cure rate due to collagen injections alone is 53 per cent (17 of the 32 cases). A total of 41 injections were performed and no post-operative complications were observed.

A standardized parameter for the distribution of individual red blood cell deformability with the cell transit analyzer.

The purpose of this study was to identify a parameter allowing the standardization of the Cell Transit Analyzer (CTA) in order to study the individual deformability of each explored Red Blood Cell (RBC). Using theoretical arguments based on the principle of the CTA, we calculated the thickness "x" of the crown of fluid surrounding each RBC during its entry phase into the micropore. A mathematical equation (x = 62.5/magnitude of dU) was established between the difference of potential (dU, mV) that occurs during this phase and the corresponding thickness ("x", micron) of the crown. By exploring fresh control RBCs of healthy subjects and assuming that the rigid RBCs proportion in a fresh blood sample of healthy subject is less than 3.5%, we performed a thresholding of "x" to distinguish rigid RBC from deformable ones. That thresholding was necessary to stamp the variability of counts linked to polycarbonate filters (PF) used to carry out measures. According to the PF, the value of the threshold "Tx" provided by the thresholding ranged between 0.222 and 0.246 micron. Using the values of "Tx", we counted approximately 10-25% rigid RBCs in the pathological samples of four patients with sickle cells SS disease and of one diabetic patient with splenomegaly. We observed in addition that the percentages of rigid RBCs counted after thresholding are identical from a filter to another one with an absolute error less than 2% in fresh RBCs (normal or pathological) samples. We concluded that the method of standardization by thresholding presented here could be used in clinic routine to count the rigid RBCs percentage contained in a given sample.

[Current resistance status of Escherichia coli strains from bovine mastitis milk samples]. / Aktuelle Resistenzsituation von Escherichia-coli-Stämmen aus bovinen Mastitismilchproben.

Between December 1996 and March 1997, 95 E.coli strains were isolated from mastitis milk samples from 95 different animals. In 29.5% resistance could be observed against one or several of the examined antibiotics. However, Cefoperazone, Polymyxin B, Colistin and Gentamycin proved effective against the majority of these strains. Between 0 and 23% of E.coli were resistant against the single tested antibiotics. As opposed to earlier investigations a smaller number of Chloramphenicol-resistant strains could be found. One strain with multiple resistance was also resistant against Gentamycin. However, in the treatment of mastitis the resistance of a particular agent is only one among several contributing factors.

[Chronic indigestion in milk-fed calves]. / Chronische Indigestion beim Milchkalb.

Calves with chronic indigestion have disturbed general attitude and condition, decreased appetite, loss of hair, clay-like faeces and ruminal and metabolic acidosis. Possible causes include dysfunction of the oesophageal-groove reflex, reflux of abomasal contents into the rumen and abnormal ruminal motility. The anion gap may be increased or within normal limits. Metabolic acidosis is significantly more severe in calves that are unable to stand than in calves that can stand. Treatment of chronic indigestion consists primarily of intravenous administration of sodium bicarbonate, transfaunation of the rumen and oral administration of electrolyte solutions.

[The animal health card for dairy cows--an instrument for veterinary herd health care and quality assurance in milk production]. / Die Tiergesundheitskarte für Milchvieh--ein Hilfsmittel zur tierärztlichen Bestandesbetreuung und Qualitätssicherung in der Milcherzeugung.

A chart (62 x 82 cm) for veterinary herd health management based on a hand written card system is presented. The chart serves basic needs especially in small Swiss dairyherds. It is easily understood and immediately installed for the end user, the farmer and veterinarian. Furthermore an EXCEL-based tool is programmed to assist in standard data analyses. This chart meets the needs for documentation in quality assurance programs within dairy production.

[The supply of newborn camel foals (Camelus dromedarius) with immunoglobulin G]. / Untersuchungen über die Versorgung von neugeborenen Kamelfohlen (Camelus dromedarius) mit Immunglobulin-G.

A major problem in camel breeding in East Africa is the high mortality rate of young camel calves. The purpose of this research was to examine the quality of camel colostrum and extent of the calves passive immunization by maternal antibodies. In 31 camel birth on a ranch in Kenya, IgG concentrations in the colostrum and in the serum of the calf during the first three days of life were measured. IgG concentration in the serum of the calf reaches a maximum 24 hours after birth. In 39% of the examined calves, this maximum concentration was below 4 g/l. In 61% of the calves, an IgG concentration of more than 4 g/l was reached. No correlation was found between diseased animals and the IgG concentrations in the serum of the calves involved. A minor IgG concentration can be excluded as a reason for calves mortality. The high percentage of insufficient IgG concentration in the serum of the calves therefore must be caused by insufficient intake of colostrum. Future measures in order to decrease calves mortality must therefore try to improve the management of calves, especially the sufficient intake of colostrum.