Increased echogenicity of renal cortex: a transient feature in acutely ill children.

OBJECTIVE: The purpose of our study was to determine the frequency of hyperechogenicity of renal parenchyma in children with acute abdominal illness and to evaluate the assumed transient feature of this hyperechogenicity. MATERIALS AND METHODS: Between January 2005 and February 2006, 189 consecutive patients (112 boys and 77 girls; mean age, 10 years) presenting with acute abdominal pain were examined with sonography. Patients with a known history of renal disease and those with acute urinary tract infection were excluded from the study. Echogenicity of the renal cortex in comparison with adjacent liver was recorded. Renal cortex echogenicity was divided into three groups; group 1, renal cortex echogenicity less than liver parenchyma echogenicity; group 2, renal cortex echogenicity similar to that of liver parenchyma; and group 3, renal cortex echogenicity greater than that of liver parenchyma. Patients with hyperechogenicity were reexamined with sonography after 2 weeks or more. The final sonographic diagnosis and clinical outcome were noted. RESULTS: Renal cortex echogenicity was equal to or greater than that of the liver parenchyma in 18% (n = 34) of 189 patients. Increased echogenicity of the renal cortex returned to normal in 2 or more weeks in all patients. Three patients had no follow-up. Clinical diagnoses were idiopathic acute abdominal pain (n = 74), appendicitis (n = 83), mesenteric lymphadenitis (n = 15), ileocecitis (n = 7), gastroenteritis (n = 7), Crohn's disease (n = 1), intussusception (n = 1), and pneumonia (n = 1). No concurrent renal disease was diagnosed. CONCLUSION: Increased echogenicity of renal parenchyma in children with acute illness is a transient feature and does not necessarily indicate renal disease.

[Cutaneous leishmaniasis in a Syrian refugee]. / Cutane leishmaniasis bij een Syrische vluchteling.

BACKGROUND: Cutaneous leishmaniasis is rare in the Netherlands, but it is endemic to Syria. The disease can manifest itself many years after initial exposure. Given the arrival of Syrian refugees in the Netherlands, awareness of this disease entity is warranted. CASE DESCRIPTION: A 5-year-old boy from Syria had investigations for hepatosplenomegaly. As an incidental finding a solitary, moderately demarcated, erythematous plaque was noted on his right cheek. It measured 4 × 2 cm and had a central haemorrhagic, exudative, honey-yellow slough. Due to the hepatosplenomegaly, as well as cutaneous leishmaniasis we also included its visceral form in the differential diagnosis. Additional investigations confirmed the diagnosis of cutaneous leishmaniasis. CONCLUSION: Given the rising incidence of leishmaniasis in Syria, the diagnosis of cutaneous leishmaniasis should be considered in a Syrian refugee who has an ulcerating nodule or plaque. A timely local treatment may improve long-term cosmetic outcome.

Fertility and hormonal responses to temporary relief of heat stress in lactating dairy cows.

The influence of temporary cooling on pregnancy rate and ovarian secretion of cortisol, estradiol and progesterone in Holstein cows was evaluated during the months of June to September. Cows were randomly assigned to one of five treatment groups: 1) evaporative cooling, 8 d; 2) evaporative cooling, 16 d; 3) refrigerated air conditioning, 8 d; 4) refrigerated air conditioning, 16 d and 5) controls maintained outdoors with access to shade. Estrus was synchronized by giving two injections of prostaglandin (25 mg). Cows in the cooled groups were placed in box stalls at the time of the second prostaglandin injection, allowing them to be cooled for approximately 3 d prior to breeding. Blood samples were taken on days 0, 5, 10, 15, 20 and 25 postbreeding and serum was analyzed for estradiol, cortisol, progesterone and a pregnancy-specific protein. Pregnancy rates as determined by palpation per rectum at 40 to 60 d post breeding were not different between cows in cooled treatments, regardless of duration or type of cooling. Pregnancy rate was higher (P<0.05) in cooled as compared to control cows. Serum progesterone concentrations were higher on Day 15 in cooled cows as compared to control cows. No differences in serum estradiol or cortisol concentrations were observed between cooled and control cows. Pregnancy-specific protein determinations indicated that 50% of both cooled and control cows conceived. Results indicate that temporary cooling increased pregnancy rates by increasing embryonic survival rates.

Influence of feeding Aspergillus oryzae fermentation extract on the milk yields, eating patterns, and body temperatures of lactating cows.

Trials were conducted to evaluate effects of a fermentation extract of Aspergillus oryzae (AO) on milk production and composition, diet digestibility, and rectal temperature changes in lactating dairy cows. Treatments were incorporated as a top dressing at the morning feeding and consisted of control (90 g/d of ground sorghum) or AO (3 g of culture + 87 g of ground sorghum daily). Twenty-four mid-lactation Holstein cows were paired for production in Lactation Trial 1 (LT-1). In Lactation Trial 2 (LT-2), 46 cows (20 primiparous and 26 multiparous) in early lactation were used. Trials lasted 12 wk. In LT-1, AO supplementation increased milk yields only at 2 (P less than .05) and 8 wk (P less than .10) of treatment. Rectal temperatures were lower (P less than .05) for cows fed AO for 4 of 10 readings made during summer. Supplementation of AO culture in LT-2 (early lactation cows) increased milk production and feed efficiency (P less than .05). Inner ear temperatures tended to be lower (P less than .11) for cows fed AO. Digestion trials, conducted at the end of lactation trials, used Cr2O3 as an indigestible marker. In Digestion Trial 1, digestibilities were not significantly (P greater than .10) affected by AO supplementation. However, in Digestion Trial 2, AO increased (P less than .05) digestibilities of DM, OM, CP, NDF, and ADF. Length and number of meals were not affected (P greater than .10) by feeding AO. In summary, milk yields, efficiency of milk production, and nutrient digestibilities were higher for early lactation cows fed a high-concentrate diet supplemented with 3 g of AO/d. Mid-lactation cows fed a lower-energy diet were less responsive to AO than early lactation cows, though similar trends were shown.

[What carries more weight, safety or freedom? Contact persons on physical restraint of psychogeriatric nursing home patients]. / Wat weegt zwaarder, veiligheid of vrijheid? Contactpersonen over fixatie van psychogeriatrische verpleeghuispatiënten.

All representatives of psychogeriatric patients of two Dutch nursing homes (in Nijmegen and Amsterdam) were asked for their opinion about the use of (physical) restraints. Questions referred to characteristics of the respondents and their relatives in the nursing home, information provided by the nursing home, and decision-making. Furthermore respondents' opinion was studied by means of statements on six patient cases for whom respondents could choose the application of any type of restraint or no restraint. 77% (321) of all 416 representatives who were sent a questionnaire responded. The majority (75%) was well informed on the existence of several types of physical restraints, one third of the respondents, however, answered that information provided by the nursing home in this respect was lacking. 55% of the respondents answered that there was only a need for information on physical restraint when a problem concerning their family member actually occurs. Almost 90% of the respondents wanted to play an active role in decision-making or at least be informed before or shortly after application of a restraint. From the answers on the statements a majority of the respondents may be concluded to choose for safety above freedom for their relatives. Belts tied to a chair or bed, but also chairs with tables across, were judged to be the most restraining and influential on the mood of the relatives. The answers regarding the six patient cases show that a majority of the respondents choose any type of restraint. In most cases they choose for less restraining devices and for devices with less or no influence on the mood. About one-third of the representatives of the Amsterdam nursing home answered that their relatives ever had had any application of a restraint, while in the Nijmegen nursing home this prevalence was twice as high. In many aspects Amsterdam respondents were more critical about the application of restraints. This could probably be explained by the difference in policy of restraint application between the two nursing homes.

Clinical differentiation between acute appendicitis and acute mesenteric lymphadenitis in children.

INTRODUCTION: Acute mesenteric lymphadenitis in children has a clinical presentation very similar to that of acute appendicitis. The aim of this study was to evaluate whether it is possible to clinically differentiate between acute appendicitis and acute mesenteric lymphadenitis in children. METHODS: A prospective cohort analysis was performed for all children (<17 years) presenting to the emergency department of our institution with acute abdominal pain between June 2005 and July 2006. The relevant clinical parameters, clinical and radiological diagnoses and all management decisions were scored prospectively. Ultrasound was the primary imaging modality for the majority of patients. All patients were re-evaluated until a final diagnosis was attained. The Alvarado score was calculated retrospectively, and a logistic regression model was used to analyze the diagnostic potential of clinical parameters. RESULTS: 289 patients were eligible for analysis. 38 patients had acute mesenteric lymphadenitis, and 69 patients had acute appendicitis as a final diagnosis. The positive predictive values of the clinical diagnosis, the Alvarado score and the logistic regression model were 0.62, 0.81 and 0.79 respectively. Ultrasound had a positive predictive value of 96% for acute appendicitis. CONCLUSION: It is not possible to accurately distinguish acute mesenteric lymphadenitis from acute appendicitis in children using clinical evaluation alone. Ultrasound should be performed in equivocal cases.

Effects of a hot climate on the performance of first lactation Holstein cows grouped by coat color.

Dairy Herd Improvement data from 432 Holstein cows were analyzed to determine if coat color was a significant source of variation in the performance of first lactation cows in a hot climate. One of three coat color scores was subjectively assigned to first lactation Holstein cows. White coat color was less than 40% black (15% of the cows), mixed coat color was 40 to 60% black (42% of the cows), and black coat color was greater than 60% black (43% of the cows). Coat color by season of freshening interaction was not an important source of variation for any of the production traits studied; but cows were cooled during the first 130 d of lactation, perhaps removing any advantage white cows may have had during the summer months. The interaction between coat color and season of freshening was significant for days open and services per conception. White cows freshening in February and March required fewer services per conception and had fewer open days than the mixed and black cows. The heritability estimate of coat color was .22 using a paternal half-sib analysis. Additional studies, with more white cows represented, would be useful to elucidate the effects of coat color on production in a hot climate.

Influence of season and microclimate on fertility of dairy cows in a hot-arid environment.

Records were obtained over a 3 year period from six Holstein dairy farms of 300 to 500 cows each in the Phoenix, Ariz. area. Dairies were selected on the basis of similar management practices, herd size, milk production and facilities (with the exception of cooling systems). Microclimatic modifications (two dairies each) were shade only (approximately 3.7 m2/cow), evaporative-cooled shades and low-pressure water foggers under the shades. Data were categorized by season of calving (spring, Feb.-May; summer, June-Sept.; and fall, Oct.-Jan.). Traits evaluated were calving interval, days open and services/conception. Calving interval was shortest for cows calving in the spring (378 days), intermediate in fall (382 days) and longest in summer (396 days). Similar seasonal trends were observed for days open (103, 103 and 119 days, respectively) and services/conception (1.54, 1.81 and 1.93, respectively). All differences between spring and summer were significant (P less than 0.05). Calving interval and days open were less for evaporative-cooled groups (374 and 98 days, respectively), with no difference between shade only and foggers (391 and 392 days, 112 and 116 days, respectively). Services/conception were similar for all groups (1.72 to 1.79). A significant interaction between microclimate and season for services/conception could be interpreted as (i) smaller season differences for evaporative-cooled groups than for shade or foggers, or (ii) a change in the ranking of control and fogger groups during summer versus fall. Evaporative cooling was more effective than fogging for reducing the detrimental effects of seasonal high temperatures on fertility.

Hormonal alterations in the lactating dairy cow in response to thermal stress.

The influence of acute exposure to thermal stress on the secretion of progesterone, estradiol, cortisol, and LH was monitored in 14 lactating Holstein cows. Eight cows were maintained throughout the summer in a refrigerated air-conditioned tie stall barn. An additional eight cows were maintained in outdoor corrals with access only to shade. Rectal temperatures and respiration rates of cows under heat stress conditions were elevated above the cows maintained under air conditioning. Cows in both environments exhibited similar serum concentrations of progesterone and estradiol throughout the estrous cycle. Serum cortisol concentrations were higher in heat-stressed cows compared to cows maintained under cooling. The number of LH pulses on d 5 of the estrous cycle was greatly reduced in the heat-stressed cows compared to the cows under cooling. No differences in the number of pulses of LH were observed on d 12 of the estrous cycle between cows in the two environments. Data suggest that heat stress can suppress anterior pituitary release of LH without having a measurable influence on ovarian steroid hormone secretion.

Influence of environment on passive immunity in calves.

Passive immunity in neonatal calves is influenced by environment. Placing newly born Holstein calves (108 head) in three different housing environments (shade, cooled shade, hutch) during hot weather produced differences in body temperature, serum cortocosteroids, immunoglobulin IgG1 concentrations, and mortality. Experimental design permitted examination of effects due to treatments, time, differences in colostrum, and climatic environment in an analysis of variance. Calves exposed to the hotter, less desirable environment responded by having a higher mortality, higher serum corticosteroid concentration, and lower serum immunoglobulin IgG1 at 2 and 10 days after birth. All of these were correlated. Calves that died had serum immunoglobulin IgG1 falling below the mean for all experimental calves.