Complication rate, outcome, and risk factors associated with surgical repair of fractures of the lateral aspect of the humeral condyle in dogs.

OBJECTIVE: To determine outcome, report complications, and risk factors for complications associated with the surgical treatment of fractures of the lateral aspect of the humeral condyle (FLHC) in dogs. STUDY DESIGN: Fifty dogs with FLHC that had been repaired surgically were included in this retrospective case series. METHODS: The medical records and radiographs from 50 dogs with FLHC from 1990--2006 were analyzed. RESULTS: The complication rate was 30%. For every 30-minute increase in surgical time the odds of a complication increased by 2.00 (95% CI: 1.06, 3.77). For every 10 degrees increase in the angle between the transcondylar screw and a line between the epicondyles viewed on a craniocaudal radiograph there was a 4.82 (95% CI: 1.23, 18.86) greater odds of an intracondylar fracture gap appearing on postoperative radiographs. When an intracondylar fracture gap was present after surgery there was a 25% long-term radiographic outcome failure rate, whereas there was a 0% radiographic failure rate in the dogs in which an intracondylar fracture gap was not present. In conclusion, transcondylar screw placement parallel to the epicondylar line should be attempted for the repair of FLHC. An increase in surgical time leads to an increase in postoperative complication rate. The presence of an intracondylar fracture gap may be associated with fracture failure. CLINICAL SIGNIFICANCE: Screw angulation predisposed to postoperative intracondylar fracture gap which in turn may be associated with higher fracture fixation failure rate. The dogs that had prolonged surgical times had an increased complication rate.

The anatomy of the common canaliculus.

BACKGROUND: The functional valve between the common canaliculus and the lacrimal sac has traditionally been attributed to the valve of Rosenmüller, although this anatomical structure has never been rigorously documented. OBJECTIVE: To define the anatomy of the canaliculus-sac junction. METHODS: Twelve rigid plastic casts of the lacrimal outflow systems were obtained in human cadaver specimens using a well-known biologic casting material (partially polkymerized monomer to which a catalyst and promoter were added). RESULTS: A consistent pattern of angulation within the canalicular system was documented. The canaliculi bend posteriorly behind the medial canthal tendon, then anteriorly to enter the sac at an acute mean angle of 58 degrees to the lateral wall of the sac. CONCLUSIONS: This consistent configuration at the canaliculus-sac junction has not been previously described and may contribute to the 1-way valve phenomenon seen in some lacrimal disorders.

Rapid and brief tolerance to (+)- and (-)-nicotine in unanesthetized rats.

When given intravenously to unanesthetized rats as a bolus dose, (-)-nicotine produced a dose-related rise in blood pressure and fall in heart rate in the dose range of 5-40 micrograms/kg. Tolerance did not develop when doses were given at 30 min intervals. At the highest dose, the effects on heart rate persisted. In addition, severe arrhythmias and apnea were observed. (+)-Nicotine at 100 micrograms/kg produced effects similar to 10 micrograms/kg of (-)-nicotine. When given at 1 min intervals, tolerance quickly developed after only 6 injections at 5 micrograms/kg and after 4 injections at 10 micrograms/kg. Tolerance to (+)-nicotine also developed rapidly and was no longer evident at 5 min. The results suggest the tolerance is related to frequency of administration and dose. The implication of these results are discussed with regard to cardiovascular disease and dependence. In addition, we postulate that the relatively low degree of biological stereoselectivity of the optical isomers of nicotine, compared with that of the enantiomers of morphine, is due to the simplicity and flexibility of the nicotine molecule. It can be shown using Dreiding models that the nitrogen atoms in the enantiomers are nearly superimposable.

Presence of serum and tissue forms of N-acetyl-beta-glucosaminidase in urine from patients with renal disease.

1. The A, B, I1 and I2 forms of N-acetyl-beta-glucosaminidase present in urine, serum, kidney, liver and cerebral spinal fluid were separated on DEAE-cellulose and their presence confirmed by cellogel electrophoresis. The relative activities of each enzyme were determined by integrating the area under the elution peaks. 2. Serum A-form was eluted at a lower molarity of chloride than liver A-form and this was designated the As-form to distinguish it from the A-form of N-acetyl-beta-glucosaminidase found in liver and kidney. 3. The P-form of N-acetyl-beta-glucosaminidase present in the serum of a group of pregnant women was not detectable in urine samples from the same women. 4. Urinary NAG activities were found to be abnormally high in patients with impaired renal function. 5. The activity of both N-acetyl-beta-glucosaminidases A and B increased in pathological urines. The higher the total N-acetyl-beta-glucosaminidase activity excreted the higher the % of activity of the B-form present. 6. In a number of patients with haematuria an A-form similar to the serum As-form was present in the urine.

Automated assay of N-acetyl-beta-glucosaminidase in normal and pathological human urine.

An automated method for the assay of N-acetyl-beta-glucosaminidase in human urine is described and a normal range of urinary N-acetyl-beta-glucosaminidase activity is reported. The automated method has been used routinely over a twelve month period in two London hospitals for monitoring the excretion of N-acetyl-beta-glucosaminidase in renal transplant patients. The abnormal elevation of urinary N-acetyl-beta-glucosaminidase provides an early warning of rejection by indicating the presence of renal parenchymal damage. The automated assay of urinary N-acetyl-beta-glucosaminidase may also be used in screening for the presence of renal disease.

Repair of upper eyelid retraction: a comparison between adjustable and non-adjustable sutures.

BACKGROUND: The challenge with the surgical repair of upper eyelid retraction is to obtain a more predictable and satisfactory postoperative eyelid contour and height, and to minimise the need for further surgery. METHODS: A retrospective analysis was performed on all patients treated surgically for eyelid retraction at Moorfields Eye Hospital over a 13 year period. RESULTS: In this study good postoperative results were obtained in 10 of 13 (77%) eyelids using adjustable sutures, compared with 56 of 148 (38%) eyelids using non-adjustable sutures (p < 0.01). With non-adjustable sutures, good results were achieved more often for non-thyroid compared with thyroid related eyelid retraction (26/55 versus 31/93 eyelids respectively, p < 0.05). Previous eyelid surgery did not affect outcome. CONCLUSION: We recommend the use of adjustable sutures for the repair of upper eyelid retraction, particularly in patients with thyroid disease.

Orbital expansion of the congenitally anophthalmic socket.

BACKGROUND: Congenital anophthalmos is a rare condition in which intervention at an early age can stimulate orbital expansion and maximise facial symmetry. Much is still unknown, however, regarding the degree of soft tissue and bony orbital growth achieved using the orbital expanders presently available. METHODS: A retrospective review of 59 congenitally anophthalmic orbits in 42 patients was carried out. RESULTS: The soft tissue and bony orbital expansion achieved using serial solid shapes is reported, and experience with hydrophilic expanders and inflatable silicone expanders is reviewed. CONCLUSION: Although serially fitted solid shapes in the orbit lead to increased expansion of orbital soft tissue and bone compared with no orbital implant, further orbital tissue enlargement is required. The inflatable silicone expander may allow more rapid and extensive orbital tissue expansion, but design changes are needed to achieve this.

Urinary excretion of lysozyme and N-acetyl-beta-D-glucosaminidase in the diagnosis of renal allograft rejection.

The urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG) has been claimed to be of high diagnostic value in indicating acute renal graft rejection. Similar claims have been made for the significance of urinary lysozyme excretion. Serial measurements of urinary lysozyme and NAG have been made in 35 patients after renal transplantation, and during 52 suspected rejection episodes. A close correlation has been found between these two parameters although they did not consistently change in parallel. The use of both assays may give a better indication of impending rejection than either assay alone.

The role of neurotransmitters in stress-induced antinociception (SIA).

The role of the neurotransmitters, norepinephrine, dopamine and serotonin in stress-induced antinociception (SIA) was examined by altering neurochemical tone with appropriate pharmacological tools. Quipazine (15.0 mg/kg, IP) a serotonin agonist, increased the peak and duration of antinociception following stress and BC-105 (3.0 mg/kg, IP), a serotonin antagonist, blocked the increase of tail-flick latency following stress. Clonidine (0.1 mg/kg, SC) an alpha 2 agonist, markedly decreased SIA whereas phenoxybenzamine (2.5 mg/kg, IP), an alpha 1 antagonist, increased the peak and duration of SIA. When dopaminergic tone was increased with apomorphine (0.05 mg/kg, SC) the increase of tail-flick latency after stress was markedly attenuated whereas blockage of dopamine receptors with haloperidol (2.5 mg/kg, IP) increased the peak and duration of SIA. Alterations of serotonergic, but not noradrenergic or dopaminergic, tone had similar effects on increased latency in tail-flick test produced by brain stimulation produced analgesia (SPA), morphine and SIA. These data support the hypothesis that alterations in tail-flick latency involves a serotonergic system.

A simple technique for the prevention and management of Jones bypass tube extrusion.

We propose a simple technique for modifying a Jones bypass tube to prevent extrusion. It has been used in eight patients followed for 3 months to 3 years, without evidence of extrusion.

Plasma concentrations of nicotine in rats during tolerance and chronic exposure studies.

A convenient GC/MS method for the quantitation of nicotine is described. Brief and rapid tolerance to the hypertensive action of nicotine was observed during acute administration. Rats continuously exposed to (+)- or (-)-nicotine for 6 days showed significant dose-related suppression of water intake and body-weight decreases for the initial 4 days; then water consumption slowly returned to control levels, while body weight increased, but failed to reach control levels. During the withdrawal period, water consumption rose to levels significantly higher than that of the tartaric acid and water controls. Body weight during the withdrawal phase continued to increase but remained below those of control animals. Blood concentration of nicotine during acute tolerance was found to be 64.3 +/- 17.8 ng/ml whereas the saline controls showed levels of 0.67 +/- 0.67 ng/ml. Nicotine levels which were not detectable before the administration of nicotine, were elevated and constant during days 1 and 6 of the infusion period (320 +/- 80 ng/ml of plasma) and fell to below levels of detectability 24 hr after the termination of the infusion.

Functional and dispositional tolerance develops during continuous cocaine exposure.

Despite the fact that high doses of cocaine are abused chronically, relatively little is known regarding the development of tolerance and/or sensitization under these circumstances. Therefore, male Sprague-Dawley rats were infused continuously i.v. for 10 days, at a rate of 150 mg/kg/day (0.1 mg/kg/min) with cocaine hydrochloride. Body weight, food and water consumption, urine and fecal excretion, as well as blood pressure, heart rate and stereotypic behavior were monitored daily. Blood samples were also drawn daily so that plasma could be analyzed for cocaine and BEG by gas chromatography/mass spectrometry. Severe body weight loss on days 1 through 4 was followed by a gradual return to pre-drug levels. In addition, cocaine's effects on food and water consumption and urine and fecal excretion, which were maximal by day 2, were imperceptible by day 5. Complete tolerance developed rapidly to the remarkable rise in blood pressure noted on the first day. However, tolerance did not develop to the cocaine-induced increase in heart rate. A profound decrease in heart rate was noted in some animals which was interpreted to be cardiotoxicity since these animals subsequently died. On the other hand, sensitization or intensification of behavioral stereotypy occurred during the first 2 days followed by complete tolerance to this effect by day 5. No withdrawal phenomena were noted 24 h after cocaine was abruptly withdrawn. Plasma concentrations of cocaine rose rapidly during the first day and remained elevated at a constant level until day 5. Then, a sharp decline in plasma levels occurred at day 6 which remained depressed for the duration of the infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Mental illness, functional impairment, and patient preferences for collaborative care in an uninsured, primary care population.

OBJECTIVE: Our goal was to compare the prevalence of mental illness and its impact on functional status in an indigent uninsured primary care population with a general primary care sample. We also hoped to assess patient preferences about mental health and medical service integration. STUDY DESIGN: We compared a survey of consecutive primary care adults in April and May 1999 with a 1997-98 survey of 3000 general population primary care patients. Both studies used the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire and the 20-question Medical Outcomes Study Short Form. POPULATION: The patients were from a private nonprofit primary care clinic in Grand Junction, Colorado, that served only low-income uninsured people. We approached a total of 589 consecutive patients and enrolled 500 of them. MAIN OUTCOME MEASURE: The main outcomes were the prevalence of psychiatric illnesses and the relationship with functional impairment. We compared our findings with a more generalizable primary care population. RESULTS: This low-income uninsured population had a higher prevalence of 1 or more psychiatric disorders (51% vs 28%): mood disorders (33% vs 16%), anxiety disorders (36% vs 11%), probable alcohol abuse (17% vs 7%), and eating disorders (10% vs 7%). Having psychiatric disorders was associated with lower functional status and more disability days compared with not having mental illness. Patients indicated a preference for mental health providers and medical providers to communicate about their care. CONCLUSIONS: This low-income uninsured primary care population has an extremely high prevalence of mental disorders with impaired function. It may be important in low-income primary care settings to include collaborative care designs to effectively treat common mental disorders, improve functional status, and enhance patient self-care.