Development of a valid, cost-effective laparoscopic training program.

BACKGROUND: Practical programs for training and evaluating surgeons in laparoscopy are needed to keep pace with demand for minimally invasive surgery. METHODS: At the University of Kentucky five inexpensive simulations have been developed to train and assess surgical residents. Residents are videotaped performing laparoscopic procedures on models. Five surgeons assess the taped performances on 4 global skills. RESULTS: Creating mechanical models reduces training costs. Trainees agreed procedures were well represented by the simulations. Blinded assessment of performances showed high interrater agreement and correlated with the trainees' level of experience. Nonclinician evaluations on checklists correlated with evaluations by surgeons. CONCLUSIONS: Inexpensive simulations of laparoscopic appendectomy, cholecystectomy, inguinal herniorrhaphy, bowel enterotomy, and splenectomy enable surgical residents to practice laparoscopic skills safely. Obtaining masked, objective, and independent evaluations of basic skills in laparoscopic surgery can assist in reliable assessment of surgical trainees. The simulations described can anchor an innovative educational program during residency for training and assessment.

Isolation and characterization of Bordetella bronchiseptica from cats in southern Louisiana.

The role of Bordetella bronchiseptica in respiratory disease of domestic cats is currently being explored. Clinical and experimental studies in the United Kingdom have shown Bordetella bronchiseptica to be a primary respiratory pathogen in cats; similar studies in the United States are limited. The purpose of this study is to report on the isolation, seroprevalence, and partial characterization of Bordetella bronchiseptica from shelter cats in southern Louisiana. A total of 614 cats from four local shelters were studied. All cats appeared to be asymptomatic for signs of respiratory disease. Bordetella bronchiseptica was isolated in 19/614 (3.1%) cats by oropharyngeal swab and in 6/614 cats by bronchial lavage. Using an antibody capture ELISA method, 148/614 (24.1%) cats were seropositive for Bordetella bronchiseptica. The 25 isolates of Bordetella bronchiseptica were further characterized by ribotype analysis, and a total of 17 different ribotypes were identified. Specific pathogen-free kittens were experimentally infected with five of the isolates, and four of the five isolates induced clinical signs typical of feline bordetellosis. It is concluded that Bordetella bronchiseptica is present in the cat population in southern Louisiana, the organism can be isolated from asymptomatic cats, some of these isolates can produce disease in specific pathogen-free kittens, and that Bordetella bronchiseptica isolates from cats in a relatively small geographic area are genetically diverse. This and other studies indicate that Bordetella bronchiseptica should be considered in cases of feline respiratory disease.

Determinants of competency judgments by experienced laparoscopic surgeons.

BACKGROUND: The definitive criteria for assessing competence remain elusive. In our study, we aimed to identify the determinants of competence assessment used by individual laparoscopic surgeons. METHODS: In a blinded fashion, five laparoscopic surgeons rated 27 subjects on three laparoscopic simulations in four skill categories: clinical judgment, dexterity, serial/simultaneous complexity, and spatial orientation. The raters then assessed overall subject competence for each procedure. Point-biserial correlational analyses and cluster analyses were performed to ascertain the relationships among the various scales. RESULTS: All of the correlations between the skills' ratings and competence judgments were statistically significant ( p <.05). No skill rating was consistently more highly correlated with the competence rating. There were no distinct patterns of correlations for each rater or each procedure. One factor emerged from each cluster analysis of the skills measures. CONCLUSIONS: The results suggest that the four skills scored in the study are highly correlated with each other and are important in determining competence. The cluster analyses revealed that the surgeon raters shared a common perception of competence.

Antibodies to Ehrlichia canis, Ehrlichia platys, and spotted fever group rickettsiae in Louisiana dogs.

Antibodies to Ehrlichia canis, Ehrlichia platys, and spotted fever group (SFG) rickettsiae were detected by indirect immunofluorescence in sera from 27 ill individually owned thrombocytopenic dogs (platelet concentrations less than 200,000 platelets/microliters) and 59 healthy kenneled dogs located in southern Louisiana. Platelet concentrations less than 100,000 platelets/microliters were detected in 63% of ill thrombocytopenic dogs and 6.8% of healthy kennel dogs. One ill thrombocytopenic dog had intracytoplasmic E platys morulae detected within platelets. The prevalence of increased serum antibody titers to E canis and E platys was 25.9% and 40.7% for the ill thrombocytopenic dogs and 20.3% and 54.2% for the healthy kennel dogs, respectively. All dogs with seropositivity to E canis had increased antibody titers of greater than or equal to 1:100 to E platys. Simultaneous examination of increased serum antibody titers (greater than or equal to 1:64) to four SFG rickettsiae indicate that Rickettsia rhipicephali and Rickettsia montana accounted for the majority of the antibodies detected in these dogs. Of 86 dogs tested, 44.2% were seronegative to E canis, E platys, and SFG rickettsiae.

Studies on the pathogenesis of Escherichia coli in the bursa of Fabricius (cloacal bursa) of the turkey.

Turkey poults were inoculated with avirulent or virulent strains of Escherichia coli by direct application to anal lips and were killed at postinoculation hours (PIH) 0.1, 2, 5, 10, 24, 48, 72, and 96. Bursae of Fabricius (cloacal bursae) were collected, cultured, and examined by light, fluorescent, and electron microscopy. The virulent strain of E coli was not recovered from the bursae after PIH 24, although the avirulent strain was recovered up to PIH 96. The E coli strains neither localized at nor associated with the bursal fold epithelium, passed through the follicular pad epithelium, nor caused cytopathologic changes in the lymphoid follicle. A mild catarrhal bursitis was observed at PIH 48 with the avirulent strain of E coli.

Prevalence of parasitism diagnosed by fecal examination in Louisiana dogs.

The prevalence of canine intestinal parasitism was evaluated by fecal examination of 4,058 dogs admitted to the Louisiana State University Veterinary Teaching Hospital and Clinics from March 1977 to March 1980). One or more species of parasites was identified in 2,048 (50.5%) dogs. Hookworms were encountered in 38.5% of the dogs examined, whipworms in 14.9%, ascarids in 8.5%, coccidia in 2.6%, tapeworms in 2.2%, and giardia in 0.8%. Single parasitic infection was present in 1,456 (35.9%) dogs. For hookworm and whipworm infections, male dogs were significantly (P less than .05) more often affected, compared with females or spayed females. Ascarid, coccidia, and giardia infections were more prevalent in pups than in mature dogs, whereas whipworm infections were detected less often in dogs less than 6 months of age. Hookworms were the most prevalent parasites in male (39.2%) and female (35.7%) dogs less than 6 months of age and maintained high prevalence in mature dogs. Tapeworm infections were diagnosed sporadically in all age groups. In female dogs greater than 24 months of age, significantly less parasitism was present as compared with younger females. In male dogs, the prevalence of parasitism diminished less markedly with increasing age.

Scanning electron microscopic study of the small intestine of dogs from birth to 337 days of age.

The surface morphology of the small intestine of dogs from birth to 337 days of age was studied by scanning electron microscopy. The small intestinal surface morphology was similar to that described for other species, except for irregular villous length in the duodenum, jejunum, and ileum of the dog from birth to 21 days of age. The absorptive epithelial cells and goblet cells were similar in morphology and distribution from birth to 337 days. Segmented filamentous bacteria were attached to the ileal mucosa of dogs 54 to 161 days of age.

Comparative morphology of esophageal mucosa and submucosa in dogs from 1 to 337 days of age.

Scanning electron microscopy, light microscopy, and morphometric analyses were used to examine the morphology of the tunica mucosa-tela submucosa of the cervical, thoracic, and abdominal parts of the esophagus of healthy dogs from birth to 337 days of age from 3 litters of dogs whelped and reared under controlled conditions. Apart from the absence of a lamina muscularis mucosae from the cervical part of the esophagus of all dogs examined, little regional variation was detected. However, morphologic variation associated with age was observed. The number and complexity of microplicae on surface epithelial cells, as observed with the scanning electron microscope, increased with age, particularly between 1-day-old and 21-day-old dogs. Although scanning electron microscopy revealed typical duct openings from the submucosal glands in 1-day-old dogs, light microscopy revealed few functional glands. These glands gradually developed into a complex strata of tubules and acini during the time that secretory activity and the volume fraction of the tunica mucosa-tela submucosa occupied by glands increased with age. The presence of ciliated cells in the esophagus of 1-day-old dogs was apparent with scanning electron and light microscopes. Ciliated cells were always most abundant in the abdominal part of the esophagus. Finally, morphometric analyses revealed a significant increase in epithelial and connective tissue compartment thicknesses, as well as a marked increase in the volume fraction occupied by glands between 1 day and 161 days after dogs were whelped. A smaller decrease in all 3 measures occurred between 161 and 337 days after the dogs were whelped.

Antimicrobial susceptibility of coagulase-positive staphylococci isolated from Louisiana dogs.

Disk diffusion susceptibility tests were done on 1,178 clinical strains of coagulase-positive staphylococci (CPS) isolated from dogs during a 7-year period. Relative decreases of 7% to 33% were found in the percentages of CPS sensitive to 8 antimicrobics. Relative percentages of CPS sensitive to 9 other antimicrobics were increased or decreased less than 5%. Sensitivity to the beta-lactam antibiotics showed the least relative change. Regression analysis demonstrated that the greatest change in percentage sensitivity of CPS occurred to gentamicin and cephalothin and the least change occurred to penicillin and ampicillin. Recent canine clinical isolates of CPS, specifically identified as Staphylococcus intermedius (n = 109), were uniformly sensitive to novobiocin, amikacin, tobramycin, spectinomycin, and amoxicillin-clavulanic acid. Twenty-two isolates were also sensitive to 17 other antimicrobics. Eighty-seven isolates were resistant to 1 or more antimicrobics tested. Resistance was most common to sulfonamides, penicillin G, ampicillin, tetracycline, and streptomycin. Differences in susceptibility results between S intermedius and unspecified CPS were not statistically significant.

Quantitative urinalysis in kittens from four to thirty weeks after birth.

To evaluate renal function and obtain reference values for measurements of urinary excretion of various substances, quantitative urinalysis was performed in healthy, growing kittens from 4 to 30 weeks after birth. Endogenous creatinine clearance, 24-hour urine protein excretion, and urine protein-to-creatinine ratio were determined. Additionally, fractional excretion to creatinine clearance was calculated for calcium, inorganic phosphorus, sodium, potassium, and chloride. Mean +/- SD endogenous creatinine clearance values (range, 3.80 +/- 0.48 to 4.74 +/- 0.61 ml/min/kg) were significantly (P less than 0.0001) higher in kittens 9 to 19 weeks old, compared with younger (range, 1.39 +/- 0.85 to 3.59 +/- 0.86 ml/min/kg) and older kittens (range, 2.69 +/- 0.40 to 3.46 +/- 0.37 ml/min/kg). Mean values for all kittens for 24-hour urine protein excretion (range, 2.54 +/- 1.81 mg/kg at 4 weeks to 11.39 +/- 7.61 mg/kg at 14 weeks) and for urine protein-to-creatinine ratio (range, 0.14 +/- 0.03 to 0.34 +/- 0.18) varied from week to week of age. The urine protein-to-creatinine ratio in kittens greater than or equal to 9 weeks old correlated well (R2 = 0.861) with 24-hour urine protein excretion. Urinary fractional excretion of calcium, inorganic phosphorus, sodium, potassium, and chloride in kittens varied among age groups, being significantly (P less than 0.01) different for potassium and calcium in young kittens (4 to 6 weeks) and older kittens (greater than or equal to 7 weeks).

Comparison of coagulase test methods for identification of Staphylococcus intermedius from dogs.

Staphylococcus intermedius isolates from dogs were tested for coagulase activity by 6 commercial methods and by conventional methods, using rabbit and dog plasma. When compared with the conventional tube method using rabbit plasma, none of the 6 commercial methods was suitable for identification of S intermedius, although the 6 tests performed well using strains of S aureus. Use of rabbit plasma identified more S intermedius isolates than did use of dog plasma.

Detection of beta-lactamase produced by Staphylococcus intermedius.

One iodometric, 2 chromogenic, and 3 acidometric methods were compared for the detection of beta-lactamase produced by Staphylococcus intermedius (n = 105) isolated from dogs. Of 575 tests performed, using the 6 methods evaluated, 316 (55.0%) were positive for beta-lactamase production. The iodometric method was the reference method. With the exception of a high correlation (r = 0.962) between 1 acidometric method and 1 chromogenic method, the 5 commercial methods had correlation coefficients less than 0.900 when comparisons were made among them. The 6 methods were in agreement for 69 (65.7%) of the isolates. Based on the findings of this study, an inexpensive, laboratory-prepared, paper strip iodometric method was as reliable as 5 commercial methods for beta-lactamase detection and is recommended for routine use in clinical laboratories.

Temporal study of staphylococcal species on healthy dogs.

During a 1-year period, specimens were obtained monthly from 5 hair coat and 7 mucous membrane sites of 11 healthy dogs. Among 804 isolates of staphylococci, 13 species were identified. Staphylococcus intermedius was the most frequently isolated (40.2% of total isolates) coagulase-positive species, and S xylosus was the most frequently isolated (17.3%) coagulase-negative species. Moreover, S intermedius was the most frequently isolated species from the 12 sites evaluated and was isolated persistently from 8 of the 9 dogs that completed the 1-year study. On the basis of a commercial identification system, 14 profile numbers were identified for isolates of S intermedius. However, 2 profile numbers accounted for a majority (70.9%) of the isolates. Specific S intermedius biotypes identified on the basis of hemolysis, coagulase production, beta-lactamase activity, and antimicrobial susceptibility patterns were found repeatedly in 3 dogs. Seemingly, S intermedius was a resident of the normal bacterial microflora of these dogs; however, the inability to isolate S intermedius from 1 dog during the study year indicated that not all dogs harbor S intermedius as a resident microorganism.

Comparative evaluation of a commercial microdilution method and a conventional disk diffusion method for determination of antibiograms of gram-positive cocci.

A commercial broth microdilution system for testing the antimicrobial susceptibility of gram-positive cocci was compared with the standardized disk agar-diffusion method by testing 254 clinical strains of staphylococci and streptococci using both methods. A total of 2,794 parallel determinations were made with 92.3% complete agreement between the 2 methods; of the discrepancies encountered, 3.0% were minor, 2.5% were major, and 2.1% were very major. The results indicate that the commercial microdilution system may provide a reliable quantitative method for antimicrobial susceptibility testing of clinical isolates from animals.

Distribution of staphylococcal species on clinically healthy cats.

Among 827 isolates derived from 113 clinically healthy cats, 12 species of staphylococci were identified. Staphylococci were isolated from each cat and from 54.9% of the anatomic sites evaluated. A mode of 6 (range = 2 to 11) of the 11 anatomic sites evaluated per cat yielded staphylococci. A mode of 8 (range = 2 to 12) isolates were found per cat. Staphylococcus simulans was the most isolated (43.9% of total) coagulase-negative species. Moreover, S simulans was the most isolated species from each of the 11 sites evaluated and, except for the mouth and haircoat, comprised greater than 50% of the isolates from each site. Staphylococcus intermedius was the most isolated (13.5% of the total) coagulase-positive species. Three other species (S epidermidis, S xylosus, and S aureus) comprised 32.2% of the isolates, and 7 species (S haemolyticus, S hominis, S hyicus, S capitis, S warneri, and S saprophyticus) comprised 10.4% of the isolates. Six species (S intermedius [96 of 112 isolates], S haemolyticus [20 of 22], S sciuri [17 of 18], S warneri [10 of 13], S hyicus [10 of 10], and S capitis [7 of 8]) were isolated primarily from household cats. Only 1 species, S xylosus (75 of 87), was isolated primarily from cattery cats. Haircoat specimens (n = 452) yielded 508 isolates (61.4% of the total) distributed among all 12 staphylococcal species and included greater than 50% of the isolates of all species other than S simulans and S sciuri. A more heterogeneous population of staphylococci was isolated from household cats than was isolated from cattery cats.

Feline respiratory tract disease in Louisiana.

An investigation of feline respiratory tract disease (FRD) was made involving 65 affected cats (group 1) and 65 control cats (group 2) matched for age, sex, and residence. Feline calicivirus strains (FCV), feline herpesvirus-1 (FHV-1), or both, were isolated from 59% of group 1 cats and from 7% of group 2 cats. Isolation of these viruses showed a significantly greater (P < 0.05) relative risk for group 1 cats. Virus isolations were three times more frequent from males than from females older than 1 year (both groups), but were equally distributed between males and females younger than 1 year. Bacteria and fungi had a secondary role in both FCV- and FHV-1 associated FRD. Intestinal infections of Ancylostoma spp, Dipylidium caninum, and Toxocara cati were diagnosed more frequently in group 1 cats than in control (group 2). Paragonimus kellicotti was diagnosed in 3 group 1 cats, Taenia taeniaeformis in 1 group 1 cat, Isospora rivolta in 1 group 1 cat, and Giardia cati in 1 control cat. The present study supports the current concept of a primary viral cause for development of FRD.

Serum hyperviscosity syndrome associated with Ehrlichia canis infection in a dog.

A 10-year-old male Lhasa Apso was examined because of pyrexia, vomiting, weight loss, lethargy, and disorientation. The clinical and laboratory findings were supportive of a diagnosis of serum hyperviscosity syndrome associated with an Ehrlichia canis infection. After tetracycline therapy the serum hyperviscosity syndrome and E. canis infection were successfully resolved.

Canine haemobartonellosis, canine hepatozoonosis, and feline cytauxzoonosis.

Although Lyme borreliosis (Lyme disease), ehrlichiosis, Rocky Mountain spotted fever, and babesiosis occur more frequently in dogs or cats, from a clinical standpoint, other tick-borne diseases such as canine haemobartonellosis, canine hepatozoonosis, and feline cytauxzoonosis are just as important to recognize. Information concerning these less common tick-borne diseases are discussed, including their causative agents and their relationship to disease pathogenesis, diagnosis, treatment, and prevention.

Ixodid and argasid ticks. Keys to their identification.

Ticks of the Ixodidae family are important ectoparasites of humans and animals. Of the 80 or so species found in the United States, about 20 are of veterinary importance. Ticks are second only to mosquitoes as carriers of human pathogens. The ixodid (or hard) ticks are the most common and are represented by the genera Ixodes, Haemaphysalis, Boophilus, Rhipicephalus, Amblyomma, and Dermacentor. Accurate identification of the species of ixodid ticks within an area is a prerequisite to control and eradication. Therefore, veterinarians should have a working knowledge of the biology and identity of the more common mammalian-parasitizing ticks in the United States. In the United States, the argasid (or soft) ticks are less common than the ixodid (or hard) ticks. Argasids are represented by the genera Argas, Ornithodoros, and Otobius. Although the overall anatomy of the various species of argasids is similar, their functional approaches to feeding, reproduction, host finding and preference, tick-host behavior, tick relationship to their environment, and disease association vary among species. Accurate identification of the species of argasid ticks within an area is useful in their control.

Pediatric health care and management.

Pediatric health care is an integral part of providing for the general health needs of puppies and kittens from birth to 6 months of age. Successful rearing of puppies and kittens requires providing them with a suitable environment; the correct quantities and quality of nutrients for growth; a regular schedule of feeding, sleeping, grooming, and exercise; and the stimulus that provokes micturation and defecation. The intestinal parasites, such as hookworms, roundworms, whipworms, tapeworms, Giardia, and Cryptosporidium, occur commonly in puppies and kittens. The advantages of early-age spay/neuter far outweight the risks.