Departmental audit techniques: a personal experience.

Clinical Audit is rapidly becoming an integral part of dental practice and in the hospital service much of it is now computer based. In this article the author describes his experiences of implementing audit, which may be of help to dental practitioners who wish to start effective audit schemes of their own.

Characterisation of experimental infections of domestic pigs with genotype 2.1 and 3.3 isolates of classical swine fever virus.

The early identification of classical swine fever epizootics is hampered by difficulties in recognising early signs of infection, due to a lack of specific clinical signs. In addition many textbook descriptions of CSF are based on observations of disease caused by historic, mainly genotype 1, strains. Our objective was to improve our knowledge of the diverse range of signs that different CSFV strains can cause by characterising the experimental infection of domestic pigs with both a recent strain of CSFV and a divergent strain. Conventional pigs were inoculated with a genotype 2.1 isolate, that caused an outbreak in the UK in 2000, and a genotype 3.3 strain that is genetically divergent from European strains. This latter strain is also antigenically distinct as it is only poorly recognised by the CSFV-specific monoclonal antibody, WH303. Transmission was monitored by use of in-contact animals. Clinical, virological and haematological parameters were observed and an extended macro- and histopathological scoring system allowed detailed characterisation of pathological lesions. Infection with the genotype 2.1 isolate resulted in a similar outcome to other recent genotype 2 European strains, whereas the genotype 3.3 strain produced fewer and delayed clinical signs, notably with little fever. This strain would therefore be particularly difficult to detect in the early stages of infection and highlights the importance of encouraging early submission of samples for laboratory diagnosis. As representatives of recent and divergent CSFV isolates, these strains are good candidates to study the pathogenesis of current CSFV isolates and as challenge models for vaccine development.

Assessment of left ventricular enlargement from planar thallium-201 images.

Although a subjective assessment of left ventricular (LV) size can be made from planar thallium images, the validity of this practice had not been critically assessed. The objective of this study was to determine the accuracy of planar thallium imaging in the assessment of LV size by using two-dimensional guided M-mode echocardiographic measurements as the standard. Consecutive patients (n = 100) who had clinically indicated stress thallium and echocardiography done within a time interval of 1 month were selected. LV size was classified as dilated or normal on immediate and 4-hour-delayed thallium scans by the consensus of two blinded observers. When present, perfusion defects were noted. LV end-diastolic internal diameter (LVIDd) was measured on M-mode images. The mean LVIDd was 5.7 cm in patients with dilated LVs compared with 5.0 cm in those with normal LVs (p < 0.01). By using an LVIDd of 5.6 cm as the upper limit of normal, the sensitivity and specificity of planar thallium imaging for detection of left ventricle enlargement were 87% and 86%, respectively. Corresponding positive and negative predictive accuracies in this population were 65% and 96%, respectively. There was a higher incidence of fixed defects in group 1 (p < 0.01). We conclude that LV enlargement can be easily and reliably determined from routine planar thallium images.