Ultrasonographic findings in cows with dilatation, torsion and retroflexion of the caecum.

Thirty cows with caecal dilatation underwent clinical and ultrasonographic examinations, followed by a right flank laparotomy and surgical correction. The intraoperative findings were compared with the results of the ultrasonographic examination. The appearance, position, dimensions, diameter and nature of the contents of the caecum and proximal and spiral ansa of the colon were determined with a 3.5 MHz linear transducer. The wall of the proximal ansa of the colon and of the dilated caecum closest to the abdominal wall was visible in all the cows and appeared as an echogenic semicircular line immediately adjacent to the peritoneum. The contents of the caecum and of the proximal and spiral ansa of the colon were not visible in 21, 25 and 25 cows, respectively, owing to gas. In the remaining cows, the contents were hypoechogenic to echogenic in appearance. In all of the cows, the dilated caecum was imaged from the right abdominal wall at the level of the tuber coxae. The caecum was imaged from the 12th, 11th and 10th intercostal spaces in 11, five and three cows, respectively. The caecum and proximal ansa of the colon were situated immediately adjacent to the right abdominal wall in 28 cows, but in the other two cows parts of these structures were pushed away from the abdominal wall by the liver or gall bladder. The diameter of the caecum, measured at various sites varied from 7.0 to 25.0 cm. Caecal dilatation was diagnosed on the basis of the results of rectal examinations in 28 of the cows, but in all 30 cows on the basis of the results of the ultrasonographic examinations. Dilatation and caudal displacement of the caecum were diagnosed in 18 cows; dilatation and cranioventral retroflexion of the caecum were diagnosed in six cows, and dilatation and craniodorsal retroflexion of the caecum were diagnosed in two cows. In the four other cows, the direction of the retroflexed caecum could not be determined. The diagnosis of caecal dilatation based on the ultrasonographic findings was confirmed in all the cows during exploratory laparotomy. The results of ultrasonography and exploratory surgery with regard to the position of the dilated and sometimes retroflexed or twisted caecum were in complete agreement in 18 cases, in partial agreement in eight cases, but in four cases did not agree.

Ultrasonographic examination of the caecum and the proximal and spiral ansa of the colon of cattle.

The large intestine of 10 cows was examined from the right abdominal wall with a 3.5 MHz linear transducer. The cows were then slaughtered, and the organs were re-examined in a water bath. The caecum was visualised from the middle region of the abdominal wall. It ran caudo-cranially, varied in diameter from 5.2 to 18.0 cm and was situated immediately adjacent to the abdominal wall. The lateral wall of the caecum appeared as a thick, echogenic, crescent-shaped line. It could be visualised as far cranially as the 12th intercostal space. Although its junction could not be identified, the proximal ansa of the colon was recognised on the basis of its anatomical position and its diameter, which was smaller than that of the caecum. The spiral ansa of the colon and the descending colon were situated dorsal to the caecum and could be identified by moving the transducer horizontally along the abdominal wall to the last rib. The spiral ansa of the colon was situated ventral to the descending colon, and its walls appeared as thick echogenic lines. In a contracted state, the spiral colon had the appearance of a garland.

[182 offspring of cows with bovine spongiform encephalopathy (BSE) in Switzerland. 1. Clinical findings]. / Untersuchungen an 182 Nachkommen von an boviner spongiformer Enzephalopathie (BSE) erkrankten Kühen in der Schweiz. Teil 1: Klinische Befunde.

This study involved 182 calves, heifers and cows that were the first generation progeny of cows with bovine spongiform encephalopathy (BSE). All animals underwent clinical and neurological examinations. Blood, milk, urine, ruminal fluid and cerebrospinal fluid samples were examined. Each cow underwent a specific examination for BSE which included assessment of behaviour, sensitivity and locomotion. This examination was performed twice, and there was very good agreement between the results. The most common symptom was nervousness (14 animals). In the first examination, 68 animals were mildly to moderately sensitive to touching of the head, 44 animals were hypersensitive to a halogen light and 35 animals were hypersensitive to a camera flash. Twenty-four animals reacted by kicking when the hindlimbs were touched with a broom. None of the animals had disturbances in locomotion. Based on the interpretation of all findings and the comparison of the results of the first and second examinations, 173 animals were diagnosed as free of BSE. In 9 animals, the disease could not be ruled out; however, it could not be confirmed in any of them. Histological and immunohistochemical examinations of the brain of all animals were negative for BSE (see Part 2 of the study for details). The results of this study indicate that abnormal clinical findings may occur in clinically healthy cattle. However, none of the progeny of cows with BSE exhibited clinical signs typical of BSE, such as disturbances in behaviour; sensitivity and locomotion.

Stereo-microvision. Development of an opto-electronic operating microscope.

A novel opto-electronic operating microscope has been designed and clinically tested. It consists of a small camera microscope, a central electronic unit, and a stereoscopic video monitor. Advanced miniaturization permitted ergonomics superior to those of conventional optomechanical microscopes. Electronic imaging facilitates coupling to an ultrasound navigation system which enables the neurosurgeon to verify the location of the focus in real time, correlated with CT and MRI pictures. A fully computerized, digital operating microscope will now be developed based on this prototype.

[CT/MRI correlated stereometry with ultrasound in brain surgery]. / CT/MRI-korrelierte Stereometrie mit Ultraschall für Hirnoperationen.

Today the accuracy of medical imaging systems lies between +/- 0.5 mm (CT) and +/- 2.5 mm (MRI). In neurosurgery the overall uncertainty may reach the dimension centimetres. A non-tactile ultrasonic measurement system is described that allows three-dimensional measurement with a theoretical accuracy of +/- 0.1 mm in a frequency range between 50 and 70 kHz. In practice the accuracy is better than +/- 1 mm with a repetition rate of 10 per second for the x,y,z-data sets.

[Totally implantable catheters. Experience at the University Hospital Center Vaudois from March 1984 to December 1987]. / Cathéters totalement implantables. L'expérience du Centre hospitalier universitaire vaudois de mars 1984 à décembre 1987.

With cancer patients, the venous access remains a major problem. It causes phlebitis, venous sclerosis, skin necrosis and sepsis. Its maintenance implies careful nursing and a great dependence for the patient. Arterio-venous fistulas have been abandoned and replaced by Hickman-type subcutaneous indwelling catheters. These have a complication rate, mainly infectious, of about 0.4/100 days. The development of totally implanted catheters diminishes even more this rate and improves the patient's comfort. In this article we report the experience gained from 100 cancer patients equipped with 107 catheters. 31 complications occurred over a total time of 15,421 days, this averages a rate of 0.2 complications/100 days. The respectively rate of thrombosis and infections are of 0.02/100 days each. In 61% of the cases the whole system was functional after management of the complication. This results confirm the excellent tolerance of the system, its minimal rate of complication and its great possibility of reutilization.

A computer-assisted device for the intraoperative CT-correlated localization of brain tumors.

In a series of 72 open brain tumor operations the 32P (radiophosphorus) test proved to be valuable for the removal of visually not detectable tumor residues. As during resection a topographical orientation in the depth of tumor cavities was nearly impossible, a computerized measuring device was developed which enables the surgeon to locate the tumor boundaries by simultaneous comparison with preoperative CT scans. For 32P-beta emission measurements a miniature semiconductor probe can be attached to the tip of the four-axis digitizing arm allowing the evaluation of radicality by topographic distinction between tumor ramifications and normal brain tissue. The device was tested during 3 craniotomies and the perspectives of computerized stereotaxy are discussed.