Evaluation of a sprinkler cooling system on inhalable dust and ammonia concentrations in broiler chicken production.

Workers are exposed to dust in broiler chicken production during daily work activities. Poultry dust may contain inflammatory agents (e.g., endotoxin) and inhalation exposure has been associated with pulmonary symptoms. Current practice to reduce worker exposure to poultry dust is the use of respiratory protection (e.g., elastomeric face-piece respirator with a P100 and ammonia chemical cartridge). Limited research has been conducted to evaluate engineering controls to reduce dust and ammonia concentrations in broiler chicken production; therefore, the purpose of this research was to evaluate the effectiveness of a water sprinkling system to reduce inhalable dust and ammonia concentrations in a broiler chicken house. Inhalable dust and ammonia concentrations were measured daily for the production cycle of a flock of broiler chickens (63 days). Inhalable dust was measured gravimetrically using an inhalable sampler and ammonia was measured by a direct reading sensor. Sampling was performed on a stationary mannequin inside two broiler chicken houses. One house used a sprinkler cooling system to deliver a water mist throughout the house and the second house was an untreated control. The sprinkler system activated after day 5 of chicken placement, releasing water periodically from 6 am to 10 pm. The amount of sprinkling increased at day 10 and day 15 as recommended by the manufacturer. Geometric mean (GM) inhalable dust concentrations measured in the treatment house (5.5 mg/m3) were not different (p = 0.33) than those found in the control house (6.0 mg/m3). The GM ammonia concentrations were also not different (p = 0.34) across the treatment and control house [10.6 ppm (GSD: 1.80); GM 9.51 ppm (GSD: 1.77)], respectively. The use of cost effective engineering, administrative and personal exposure controls are needed in the poultry industry to effectively reduce worker's exposure to hazardous concentrations of dust and ammonia.

Bacterial clearance, heterophil function, and hematological parameters of transport-stressed turkey poults supplemented with dietary yeast extract.

Yeast extracts (YE) contain biological response modifiers that may be useful as alternatives to antibiotics for controlling pathogens in poultry production and mitigating the deleterious effects of production stressors. The objective of the present study was to determine the ability of a commercial dietary YE (Alphamune) to modulate the immune response in male turkey poults challenged with Escherichia coli and subjected to transport stress. Alphamune was added to turkey poult diets at 0, 500, or 1,000 g/ton. Poults were challenged by air sac injection with 60 cfu of E. coli at 1 wk of age. At 3 wk of age, these challenged birds were subjected to transport stress and birds were bled and necropsied the following morning. Blood cell numbers and percentages, hematological parameters, and clinical chemistry values were determined. Oxidative burst activity of isolated heterophils was measured using stimulation with phorbol myristate acetate and a 2',7'-dichlorofluorescein diacetate assay. Data were analyzed using GLM and least squares means procedures of the SAS program. The numbers and percentages of heterophils in peripheral blood were increased and their oxidative burst activity was stimulated by YE. The stress challenge dramatically increased oxidative burst and this increase was significantly modulated by YE treatment. Serum levels of calcium, phosphorus, and triglycerides were decreased and uric acid levels, erythrocyte numbers, hemoglobin, and hematocrit were increased by YE supplementation. Bacteria were isolated from the air sac and liver of a lower percentage of birds provided with YE. These results suggest that dietary YE has potential as a nonantibiotic alternative for decreasing bacterial pathogens in turkey production.

Gastrointestinal maturation is accelerated in turkey poults supplemented with a mannan-oligosaccharide yeast extract (Alphamune).

Alphamune, a yeast extract antibiotic alternative, has been shown to stimulate the immune system, increase BW in pigs, and reduce Salmonella colonization in chickens. The influence of Alphamune on gastrointestinal tract development has not been reported. Two trials were conducted to evaluate the effects of Alphamune on gut maturation of 7- and 21-d-old turkey poults. Poults were fed a standard control unmedicated turkey starter diet or the same diet supplemented with either 1 or 2 lb/ton of Alphamune (n = 18/group). Poults were weighed on d 7 and 21, euthanized, and a 2-cm section was collected from the midpoint of the duodenum, jejunum, and ileum of each bird (9 poults/d per treatment) and fixed in a 10% formalin solution for 72 h and then stained. Twenty measurements of villus height, villus surface area, lamina propria thickness, crypt depth, and density of neutral, sialomucin, and sulfomucin goblet cells were taken per section per poult. On d 7, BW were higher for the poults given the Alphamune treatments compared with control poults; however, no differences were observed on d 21. Alphamune supplementation influenced intestinal morphology differently based on gut location. Ileum villus height, surface area, lamina propria thickness, crypt depth, and neutral, sialomucin, and sulfomucin goblet cell density were enhanced with Alphamune treatments on d 7 and 21 (P < 0.05) and in a dose-dependent manner for many of the parameters evaluated. Jejunum results were mixed. Surface area, crypt depth, and sialomucin and sulfomucin goblet cells were consistently higher for the 2 lb/ton of Alphamune groups compared with the control group on d 7 and 21. Duodenum villus height, surface area, and goblet cell density were higher for the 2 lb/ton of Alphamune groups on d 7; however, intestinal morphology of the duodenum was not different between the control and treated birds on d 21. These results suggest that feed supplemented with Alphamune can accelerate gastrointestinal maturation in turkey poults and is more pronounced in the ileum than in other portions of the small intestine.

Influence of hen age on the response of turkey poults to cold stress, Escherichia coli challenge, and treatment with a yeast extract antibiotic alternative.

Two battery experiments were conducted to evaluate a commercial yeast extract feed supplement, Alphamune, in a cold stress-Escherichia coli challenge of 1-wk-old turkeys. Experiment 1 used 1-d-old male poults that were the progeny of 33-wk-old hens in their second week of lay. Experiment 2 used male poults of the same genetic line from 40-wk-old hens in their eighth week of lay. Poults were fed a standard unmedicated turkey starter diet or the same diet with either a low level (504 g/t) or a high level (1,008 g/t) of yeast extract. Challenged birds were exposed to intermittent cold stress during wk 1 to 3 and to a respiratory E. coli challenge at 1 wk of age. In both experiments, BW at wk 1 was increased by feeding yeast extract. In experiment 1, challenged, control-fed birds had decreased BW at wk 3 and feed conversion was protected by both levels of yeast extract supplementation. In experiment 2, challenge had no effect on control-fed birds; however, yeast extract decreased the BW of challenged birds. In experiment 1, total leukocyte numbers were decreased by challenge of control-fed birds only, and there was no effect of challenge on the heterophil/lymphocyte ratio. In experiment 2, total leukocyte numbers were decreased and the heterophil/lymphocyte ratio was increased in challenged, control-fed birds. Percentage mortality was not affected by challenge in experiment 1; however, in experiment 2, mortality was increased by challenge of control-fed birds and those fed the lower level of yeast extract. These results suggest that hen age should be considered when designing studies to evaluate antibiotic alternatives and in making decisions for incorporating such alternatives into production.

Dietary lactose and its effect on the disease condition of necrotic enteritis.

Clostridium perfringens is the etiologic agent of necrotic enteritis (NE) and is ubiquitous in nature. The incidence of NE has increased in countries and commercial companies that have stopped using antibiotic growth promoters. The mechanisms of colonization of C. perfringens and the factors involved in onset of NE are not fully understood. Previously, our laboratory has demonstrated that lactose could potentially reduce Salmonella and C. perfringens in ceca of poultry. In the present investigation, we hypothesized that dietary lactose would reduce the clinical signs of NE and could be used as an alternative to antibiotics. In experiment 1, day-of-hatch broilers were fed either a nonlactose control diet, a diet with 2.5% lactose, or a diet with 4.5% lactose throughout the experiment. Birds were administered C. perfringens (10(7) cfu/mL) daily via oral gavage for 3 consecutive days starting on d 17. When evaluating the intestinal lesions associated with NE, birds fed 2.5% lactose had significantly lower (P < 0.05) lesion scores (0.70 +/- 0.52) compared with the control (1.55 +/- 0.52) or the 4.5% lactose (1.60 +/- 0.52). The data from the microbial analysis showed that the addition of lactose did not affect any bacterial populations when compared with the control birds that did not receive dietary lactose over the 21-d evaluation. The overall lesion scores in experiment 2 were significantly (P < 0.05) reduced in birds fed 2.5% lactose compared with the birds fed the control diet with mean lesion scores of 1.10 +/- 0.73 and 1.80 +/- 0.73, respectively. These experiments suggest that lactose could be used as a potential alternative to growth-promoting antibiotics to help control this costly disease.

Upregulation of oxidative burst and degranulation in chicken heterophils stimulated with probiotic bacteria.

The immune system of neonatal chicks is functionally immature during the first week of life. Researchers have previously demonstrated that the avian humoral response can be increased with probiotics. Although the humoral response provides the chick with an effective mechanism to combat pathogens, sufficient antibody titers are not attained until 7 to 10 d postinfection. However, the innate immune system (i.e., heterophils) can respond much more quickly to pathogens. The objective of this study was to determine whether probiotic bacteria can also upregulate heterophil function. Heterophils were isolated from the peripheral blood of neonatal chickens by using a discontinuous density gradient. Oxidative burst and degranulation are bactericidal mechanisms used by heterophils to kill pathogens and were used in this study as indicators of heterophil function. We found that each of the 10 "generally recognized as safe" probiotic isolates (designated G1 to G11) tested in vitro were capable of increasing (P < 0.05) heterophil oxidative burst and degranulation when compared with unstimulated controls. Bacillus subtilis (G3), Lactococcus lactis lactis (G6), and Lactobacillus acidophilus (G8) isolates were determined to elicit the greatest heterophil response in vitro and were subsequently fed to chicks. Phosphate-buffered saline or 1 of these 3 probiotic isolates (approximately 2.5 x 10(8) cfu/chick; 50 chicks/treatment) resuspended in PBS was administered by oral gavage on the day of hatch. Heterophils were isolated from chicks from each of these 4 treatment groups 24 h posttreatment. Significant increases in heterophil degranulation and oxidative burst were observed with the G3-, G6-, and G8-treated chicks when compared with heterophils isolated from birds with no probiotic treatment. These data suggest that probiotic bacteria can significantly improve heterophil oxidative burst and degranulation in broilers. To our knowledge, this is the first study demonstrating a relationship between probiotics and avian heterophil function.

Effect of oral administration of bismuth compounds on Campylobacter colonization in broilers.

Bismuth compounds have been used since the 18th century to treat gastrointestinal ailments in man. Colloidal bismuth subcitrate (De-Nol) is currently used in combination with antibiotics to reduce enteric Helicobacter pylori colonization as a treatment of stomach ulcers. We investigated whether bismuth citrate or its parent compound, colloidal bismuth subcitrate, would reduce colonization of the closely related foodborne pathogen, Campylobacter jejuni in chickens. In 2 studies, birds were either fed 0, 50, or 200 ppm bismuth citrate or bismuth subcitrate (De-Nol) for 10 or 21 d and were orally challenged with 7 combined strains of C. jejuni (n = 6 birds/treatment). For both treatment groups, cecal Campylobacter colonization was reduced when birds were fed 200 ppm for 10 d but not 21 d. For the 50 ppm treatment group, only birds dosed with bismuth citrate for 21 d demonstrated any reduction in cecal Campylobacter concentrations when compared with controls. These data suggest that bismuth citrate and colloidal bismuth subcitrate may reduce cecal colonization by Campylobacter in broilers, but these effects are inconsistent.

Bacteriocins reduce Campylobacter colonization and alter gut morphology in turkey poults.

Campylobacter is a leading cause of food-borne illness in the United States. Recent evidence has demonstrated that bacteriocins produced by Bacillus circulans and Paenibacillus polymyxa reduce cecal Campylobacter colonization in broiler chickens infected with Campylobacter jejuni. As Campylobacter coli is the most prevalent Campylobacter isolate recovered in turkeys, the objectives of the present study were to evaluate the efficacy of these bacteriocins against C. coli colonization and their influence on the gastrointestinal architecture of young turkeys. In 3 separate trials, a total of 135 day-of-hatch poults (n = 45/trial) were orally challenged on d 3 with approximately 10(6) cfu of a mixture of 3 C. coli isolates. Immediately before bacteriocin treatment (d 10), cecal Campylobacter concentrations averaged 1.1 x 10(7) cfu/ g of cecal contents (n = 15/trial). On d 10 to 12 posthatch, 2 bacteriocin treatment groups were given free access to feed supplemented with purified, microencapsulated bacteriocins, whereas the positive control treatment group had access to untreated feed (n = 10/treatment group per trial). At the end of the 3-d dosing period, ceca and duodenal loops were collected for analysis. In each of the 3 separate trials, treatment with bacteriocin eliminated detectable ceca Campylobacter concentrations (detection limit, 1 x 10(2) cfu/g of cecal contents) vs. controls (1.0 x 106 cfu of Campylobacter/g of cecal contents). Duodenum crypt depth and goblet cell numbers were also reduced in turkeys treated with either bacteriocin vs. controls (P < 0.05). The dynamic reduction in crypt depth and goblet cell density in turkeys dosed with bacteriocin may provide clues to how bacteriocins inhibit enteric Campylobacter.

Purified beta-glucan as an abiotic feed additive up-regulates the innate immune response in immature chickens against Salmonella enterica serovar Enteritidis.

Functionally, the innate immune system of immature chickens is inefficient during the first week posthatch. This immunological inefficiency enables pathogens such as Salmonella enterica serovar Enteritidis (SE) to invade and colonize the visceral organs of immature chickens. The objective of this study was to evaluate the effect of purified beta-glucan as an immunomodulator of the innate immune response. beta-glucan, as a feed additive, significantly provided protection against SE organ invasion in young chickens (P<0.05). The functional efficiency of heterophils isolated from neonatal chickens fed a beta-glucan ration was significantly (P<0.05) up-regulated when compared to heterophils isolated from chickens fed a control ration as determined with an array of functional assays. Phagocytosis, bactericidal killing, and oxidative burst were significantly increased in heterophils isolated from chickens fed the purified beta-glucan ration (P<0.05). To our knowledge, this is the first report of a purified beta-glucan feed additive significantly decreasing the incidence of SE organ invasion in immature chickens and up-regulating the functional abilities of heterophils isolated from immature chickens against an invading pathogen, SE.

Hypobaric hypoxia in ascites resistant and susceptible broiler genetic lines influences gut morphology.

Genetic selection based on rapid growth rates, improved feed conversion, and increased body weights has led to a predisposition to ascites in broiler populations. Sire-family selection was applied to a commercial elite line to produce divergent lines of ascites-resistant (RES) and ascites-susceptible (SUS) broilers by the 8th generation. One objective of this research was to determine the effects of hypobaric hypoxia on gut morphology in these genetic lines. In two separate trials, pedigree broiler chickens were randomly assigned to cages in a hypobaric chamber (simulated 2,900 m above sea level) or a matching local altitude chamber (390 m above sea level). Ascites incidence was characterized by heart enlargement and fluid accumulation in the abdominal cavity. At the end of the study on d 42, all surviving birds were killed and evaluated for the presence of ascites and 2-cm sections from the duodenum and lower ileum were collected from 5 chickens per line, per altitude for each trial for morphometric analysis. At a high altitude, ascites incidence was lower in the RES line (20.9 and 3.7%) than in the SUS line (86.4 and 66.9%, Trials 1 and 2, respectively). No ascites was observed at a local altitude. Under hypoxic conditions, duodenum villus surface area was higher (P < 0.05) in the RES line (181.3 +/- 16.8 and 219 +/- 10.9 microm) compared with the SUS line (130.1 +/- 10.5 and 134.3 +/- 9.3 microm; Trials 1 and 2, respectively). No differences in ileum villus morphology were observed for any of the parameters measured. The reduced surface area in the duodenum of birds selected for ascites susceptibility suggests reduced enteric function and may provide clues as to why these birds have increased incidence of ascites.

Effect of prebiotic on gut development and ascites incidence of broilers reared in a hypoxic environment.

Modern broilers have been genetically selected for an increased growth rate and improved feed conversion, but they are also more susceptible to ascites. Ascites occurs when there is an imbalance between available oxygen and the oxygen demand of the broiler. We hypothesized that promoting neonatal gut development with a prebiotic, such as Aspergillus meal (Prebiotic-AM), would enhance gut efficiency, decrease the oxygen demand of the gut, and reduce ascites incidence. In this study, we compared the effect of Prebiotic-AM on ascites incidence and gut development in commercial broilers reared at a local altitude (390 m above sea level) and a simulated high altitude (2,900 m above sea level). Half of the birds received a National Research Council recommended corn-soybean ration, and the other half received the same ration supplemented with 0.2% Prebiotic-AM. These 2 groups were further divided into a local altitude group and a simulated high altitude group for a total of 4 treatment combinations. Tissues were collected on d 1, 3, 7, 14, and 21 from the duodenum and lower ileum and placed in 10% buffered formalin for morphometric analysis. At a simulated high altitude, ascites incidence was 68% for birds fed the Prebiotic-AM supplement compared with 92% ascites incidence in birds given the control feed. The simulated high altitude decreased (P < 0.05) gut development, but prebiotic-treated birds reared in hypoxic conditions had similar gut development to control birds reared at local altitude. These data suggest that a feed ration supplemented with Prebiotic-AM may reduce the effect of hypoxia on broiler gut development and ascites incidence.

Mayo Clinic's hospital-based emergency air medical transport service.

Mayo Clinic's hospital-based helicopter transport service, which is staffed by a medical flight crew consisting of two critical-care nurses, was initiated in October 1984. To date, more than 2,500 patients with a wide range of life-threatening conditions have been transported. As a quality-assurance tool, a computerized data collection system was initiated in 1986, and this report details a 3-year experience in air transport garnered prospectively. From 1986 through 1988, 1,701 flights were completed in response to 2,329 requests for transport. Overall, 10% of requests were declined because of weather. Of 1,727 patients transported, 94% were brought to the Mayo Medical Center for care. The categories of the patients were medical-surgical in 1,071 (62%), trauma in 553 (32%), and neonates in 103 (6%). Most transports (93%) originated from referral inpatient facilities or emergency rooms; the rest were scene flights or transports from Mayo to other facilities. The mortality rate among the 1,632 patients brought to the Mayo Medical Center was 16.3%. The mean distance transported was 77 miles for interhospital and 23 miles for scene flights. For both trauma and medical-surgical patients, the severity of illness was evaluated with use of recognized quantitative scoring systems. Prospective collection of data has proved useful in program administration, quality assurance, and clinical research. Mayo Clinic's hospital-based helicopter transport program has served as a logical extension of the institution's emergency-care capabilities in an effort to enhance the prehospital and interhospital care of the critically ill within the institution's referral area.

Upper gastrointestinal hemorrhage.

Hemorrhage in the upper gastrointestinal tract can be a diagnostic and therapeutic challenge to the physician. Although some advances have been made in patient care, mortality from gastrointestinal bleeding has not decreased during the past 40 years. The initial priorities in the physical examination of the bleeding patient should be a rapid assessment of the hemodynamic status and evaluation of the circulatory state. Once the patient has been hemodynamically stabilized, endoscopy is the best available technique for identifying the bleeding lesion. Potential sources of the bleeding are duodenal ulcers, gastric ulcers, Mallory-Weiss tears, and esophageal varices. The classic indications for surgical intervention are loss of 30% of the estimated blood volume in the first 24 hours, a need for 1,500 ml of transfused blood per 24 hours to maintain stable hemodynamics, hemorrhage to the point of hypotension or shock, and rebleeding during medical therapy.

Hepatobiliary cancer--surgical considerations.

Most cancers of the hepatobiliary system will have grown beyond the limits of curative resection by the time they become clinically evident. This reality has fostered therapeutic nihilism, and most physicians and surgeons in their pessimism have failed to study the early modes of spread of these tumors--patterns of growth that are relevant to proper treatment of those patients who do have lesions that can be removed with hope of achieving a cure. Moreover, anatomic and technical complexities may beget surgical reluctance in the management of potentially curable lesions. Therefore, this review is offered for orientation and perspective for those who would hope to offer optimal treatment for patients who have primary cancers of the liver, gallbladder, or biliary ducts. The review includes considerations of (1) surgical anatomy, (2) modes of spread, (3) assessment of resectability, (4) surgical technique, and (5) results of operative treatment in relation to "curative" resection. Also offered are some guides to palliative surgical management of tumors that have reached the hepatic hilus.

Torsion of the gallbladder.

Herein we report two cases of acute torsion of the gallbladder, including an extremely rare instance of torsion of the fundus of the organ. Because symptoms of torsion of the gallbladder are similar to those of other diseases and because of its rarity, preoperative diagnosis is difficult. The cause of this disorder had not been determined. Torsion of the gallbladder may occur as an acute event or be subtle and recurrent. Because of the potentially catastrophic consequences of delayed surgical intervention, an abdominal operation should be performed early in patients with symptoms suggestive of acute cholecystitis, especially if a mass is palpable. The recommended treatment is cholecystectomy.

Nutritional support of critically ill patients.

Severe depletion of body protein stores can result from prolonged starvation or from hormonal and cytokine-mediated effects during critical illness. Recent advances in the understanding of cytokine actions have substantially refined the interpretation of the nutritional assessment of critically ill patients. In addition, the design of nutritional programs for hospitalized patients has changed considerably during the past decade. Although nutritional support of critically ill patients will not lead to positive nitrogen balance, nutrition can increase protein synthesis, enhance immune function, and beneficially modify the body's response to an illness.

Treatment of aortic graft infection with providone-iodine irrigation.

Considerable morbidity and mortality are associated with infections of vascular prosthetic grafts. Most vascular surgeons believe that once vascular prosthetic graft infections occur, any form of therapy short of removal of the prosthesis will fail. Although recent reports have noted the successful conservative treatment of vascular prosthetic graft infections in the groin, most surgeons have been hesitant to use such therapy for aortic prosthetic graft infections. We describe an 88-year-old woman with an aortic graft infection 2 months after abdominal aortic aneurysmectomy who was treated successfully with local debridement and continuous irrigation of the graft bed with providone-iodine solution. Such local therapy is an alternative and sometimes effective method of managing patients with infected aortic grafts in whom the risk of resection of the prosthesis and revascularization would be prohibitive.

Spontaneous rupture of the spleen due to infectious mononucleosis.

Spontaneous splenic rupture is an extremely rare but life-threatening complication of infectious mononucleosis in young adults. Although splenectomy remains effective treatment, reports of successful nonoperative management have challenged the time-honored approach of emergent laparotomy. On retrospective analysis of our institutional experience with 8,116 patients who had this disease during a 40-year period, we found 5 substantiated cases of atraumatic splenic rupture due to infectious mononucleosis. Four additional cases of suspected splenic rupture were noted. All nine patients were hospitalized and treated (seven underwent splenectomy and two were treated with supportive measures only), and they remain alive and well. In patients with infectious mononucleosis suspected of having rupture of the spleen, a rapid but thorough assessment and prompt implementation of appropriate management should minimize the associated morbidity and mortality. On the basis of review of the medical literature and careful scrutiny of our own experience, we advocate emergent splenectomy for spontaneous splenic rupture in patients with infectious mononucleosis.

Laparoscopic cholecystectomy: operative technique.

Laparoscopic cholecystectomy has become the routine procedure for most patients with symptomatic cholelithiasis. At our institution, a two-surgeon, four-cannula technique is used. In almost all patients, a pneumoperitoneum can be established with use of a closed technique. Adherence to standard operative principles and careful attention to details in the laparoscopic technique will routinely result in the safe completion of laparoscopic cholecystectomy. Cautery provides excellent hemostasis during dissection of the gallbladder from its attachments. Cholangiography through the gallbladder or the cystic duct is easily performed in selected patients. Minimal perioperative care is necessary for patients who undergo laparoscopic cholecystectomy, and the hospitalization time is usually less than 24 hours.

Laparoscopic cholecystectomy: early Mayo Clinic experience.

Prospective data and follow-up information were collected on the initial 200 patients who underwent laparoscopic cholecystectomy at the Mayo Clinic. The operation was completed laparoscopically in all but five patients, who required conversion to laparotomy because of dense scarring or stones in the common bile duct. The median surgical time was 85 minutes. The major postoperative complications were retained stones in the common bile duct (in seven patients), intraperitoneal hemorrhage that necessitated transfusion (in two patients), and intra-abdominal abscess and pulmonary infection (in one patient each). The median hospital stay was 1 day (range, 0 to 8 days), and the median times to full activity and normal employment were 8 days and 12 days, respectively. Laparoscopic cholecystectomy is associated with a low frequency of complications in most patients with symptomatic gallstones and allows a rapid return to normal activity. Currently, laparoscopic cholecystectomy is the treatment of choice for most patients with symptomatic cholelithiasis.