Visual body-scores selection and its influence on body size and ultrasound carcass traits in Nellore cattle.

Genetic parameters, genetic trends, and genetic progress of carcass traits were estimated for 12,447 Nellore individuals from different Brazilian herds. The following carcass traits were analyzed: visual body scores of conformation (CONF), precocity (PREC), and muscularity (MUSC); rump width (RW) and rump length (RL), body size (frame); and ultrasound evaluation of ribeye area (REA), backfat thickness (BFT), and rump fat thickness (RFT). Heritability estimates (± SE) for CONF, PREC, and MUSC were 0.23 ± 0.02, 0.33 ± 0.03, and 0.31 ± 0.02, respectively. The heritability estimates (± SE) for RW, RL, and frame were 0.25 ± 0.05, 0.16 ± 0.04, and 0.31 ± 0.03, respectively. Ultrasound of the REA, BFT, and RFT presented mean heritability estimates (± SE) of 0.38 ± 0.03, 0.44 ± 0.04, and 0.47 ± 0.04, respectively. The visual body score of CONF had high genetic correlations with RW, RL, and frame (0.74 ± 0.09, 0.82 ± 0.08, and 0.83 ± 0.04, respectively), indicating a high association of CONF with the measurements related to body structure. The REA had no correlation with BFT and RFT (-0.09 ± 0.04 and -0.03 ± 0.04, respectively) and showed only a moderate genetic correlation with MUSC (0.39 ± 0.05). The BFT and RFT had moderate genetic correlations with PREC (0.36 ± 0.07 and 0.29 ± 0.07, respectively) and no correlation with frame (-0.02 ± 0.03 and 0.05 ± 0.05, respectively), suggesting that selection for frame had no effect on the subcutaneous fat content of the carcass. Low genetic trends and low genetic progress were obtained for REA (0.026 cm, 0.02%), BFT (0.0031 mm, 0.05%), and RFT (0.0013 mm, 0.02%), with no significant values of genetic progress detected throughout the studied period. The CONF, PREC, and MUSC presented high genetic trends (0.030 points, 0.030 points, and 0.029 points, respectively) and high genetic progress (0.60%, 0.56%, and 0.59%, respectively), indicating a significant genetic progress for these traits throughout the evaluated period. Carcass traits evaluated by ultrasound and visual body scores are eligible for selection and can be used in genetic improvement programs in Nellore cattle; however, visual body score selection for carcass traits can result in slower genetic progress for carcass quality when compared to selection performed by ultrasound.

Lung isolation in the morbidly obese patient: a comparison of a left-sided double-lumen tracheal tube with the Arndt® wire-guided blocker.

BACKGROUND: Obese patients are at risk of complications during airway management including difficult tracheal intubation. There are no reports regarding the ease of intubation or efficiency of lung collapse with the use of lung isolation devices for the morbidly obese patient. We conducted a prospective, randomized study in morbidly obese patients undergoing one-lung ventilation. We compared the effectiveness and ease of placement of a left-sided double-lumen tube and the Arndt(®) blocker. METHODS: Fifty adult patients undergoing thoracic surgery were randomly assigned to a double-lumen tracheal tube (DLT) or standard single-lumen tracheal tube and an Arndt(®) blocker. The primary endpoint was to record the number of times the tube/devices were successfully positioned at the first attempt and the time spent to achieve optimal position as verified by fibreoptic bronchoscopy. A secondary outcome was the adequacy of lung collapse. RESULTS: For the left-sided DLT group, there were three intubation failures on the first attempt. This group required an alternative method with an airway exchange catheter technique to advance the DLT. In the single-lumen tracheal tube with an Arndt(®) blocker group, there were two intubation failures on the first attempt. After lung isolation devices were placed, lung collapse was clinically comparable in both groups. CONCLUSIONS: There is no overall advantage of one device over the other during intubation of the morbidly obese patient.

[Applications for bronchial blockers in thoracic surgery]. / Aplicaciones de los bloqueadores bronquiales en cirugía torácica.

One-lung ventilation is commonly used to facilitate visualization of the field during thoracic surgery. New devices for performing this technique that have become available over the past 2 decades include the Univent bronchial blocker incorporated in a single-lumen tube, the Arndt endobronchial blocker, and the Cohen endobronchial blocker. Although insertion of a double-lumen tube is still the method used most often to isolate the lung, bronchial blockade is an increasingly common technique and, in certain clinical settings, provides advantages over the double-lumen tube. This review provides an update on new concepts in the use of bronchial blockers as a technique for lung isolation and one-lung ventilation. The literature search was performed on MEDLINE through PubMed using the keywords bronchial blockers and thoracic surgery. The search span started with 1982-the year the first modern bronchial blocker was described - and ended with February 2006.

The first series of completely robotic esophagectomies with three-field lymphadenectomy: initial experience.

BACKGROUND: This study investigated the use of robotics to perform extended esophageal resection in a series of patients. METHODS: A total of 14 patients with a median age of 64 years underwent esophagectomy using the da Vinci robot. At presentation, there were 12 cases of cancer, staged at T2N1 (n = 2), T3N0 (n = 2), T3N1 (n = 6), T4N1 (n = 1), and M1a (n = 1); 2 cases of high-grade dysplasia; 8 cases of adenocarcinoma; and 4 cases of squamous cell cancer; as well as 2 middle third, 9 lower third, and one gastroesophageal junction tumor. Nine patients had undergone preoperative chemoradiotherapy, and six had undergone prior abdominal surgery. The patients were categorized into three chronological groups according to the procedure performed. Group 1 consisted of the first three patients in the series, whose surgery was thoracic only (robotically assisted esophagectomy). Group 2, the next three patients, had robotically assisted thoracic esophagectomy plus thoracic duct ligation using a laparoscopic gastric conduit. Group 3, the last eight patients, underwent completely robotic esophagectomy. RESULTS: For Group 3, the total operating room time was 11.1 +/- 0.8 h (range, 11.3-13.2 h), with a console time of 5.0 +/- 0.5 h (range, 4.8-5.8 h). The estimated blood loss was 400 +/- 300 ml (range, 200-950 ml). One patient in group 1 had a thoracic duct leak. In groups 2 and 3, thoracic duct ligation resulted in no further leaks. Other postoperative complications included severe pneumonia (1 case), atrial fibrillation (5 cases), cervical anastomotic leak (2 cases), wound infection (1 case), and bilateral vocal cord paresis requiring tracheostomy (1 case). In seven of the cases, no intensive care unit time was required. There was one death from pneumonia 72 days after the procedure. The rate of disease-free survival was 87%. CONCLUSION: The robotic approach facilitates an extended three-field esophagolymphadenectomy even after induction therapy and abdominal surgery. Larger scale trials are needed to define the role of this technique.

Lung isolation techniques.

Left-sided double-lumen endotracheal tubes should be the tube of choice for most cases in which lung isolation is required. A right-sided double-lumen endotracheal tube can be used effectively when a contraindication to placing a left-sided double-lumen endotracheal tube exists. The method of choice to select left-sided double-lumen endotracheal tubes is based on chest radiograph or CT scan measurements of the trachea or bronchus. Based on clinical reports, Univents or WEB blockers may be a better choice for patients with difficult airways who require one-lung ventilation or for when a selective lobar blockade is needed. For all selective intubation, the method of choice for proper tube placement and bronchial blockade is fiberoptic bronchoscopy with the patient in a supine position at first or in a lateral decubitus position later, or if a malposition occurs.

The incidence of right upper-lobe collapse when comparing a right-sided double-lumen tube versus a modified left double-lumen tube for left-sided thoracic surgery.

UNLABELLED: Lung deflation for left-sided thoracic surgery can be accomplished by using either a left- or right-sided double-lumen endotracheal tube (L-DLT or R-DLT). Anatomic variability of the right mainstem bronchus and the possibility of right upper-lobe obstruction have discouraged the routine use of R-DLT. There are, however, situations in which it is preferable to avoid manipulation/intubation of the left main bronchus, requiring placement of a R-DLT. We compared the modified L-DLT with the R-DLT to determine whether R-DLTs can be used during left-sided thoracic surgery without an increased risk of right upper-lobe collapse. Forty patients requiring left lung deflation were randomly assigned to one of two groups. Twenty patients received a modified L-DLT BronchoCath((R)) (Mallinckrodt Medical Inc., St. Louis, MO), and 20 received a R-DLT BronchoCath((R)). The following variables were studied: 1) time required to position each tube until satisfactory placement was achieved; 2) number of times fiberoptic bronchoscopy was required to readjust tube position; 3) number of malpositions after initial tube placement; 4) time required for left lung collapse; 5) incidence of right upper-lobe collapse from an intraoperative chest radiograph obtained in a lateral decubitus position; 6) overall surgical exposure; and 7) tube acquisition cost. Median time required for initial tube placement was greater in the R-DLT group (3.4 min) versus the L-DLT (2.1 min); P = 0.04. Overall tube cost was also larger for the R-DLT group (US $1819.40) versus the L-DLT group (US $1107.75). The incidence of malpositions, (five versus two), need for fiberoptic bronchoscopy, time for adequacy of left lung collapse, and incidence of intraoperative right upper-lobe collapse (0) did not significantly differ between R-DLT and L-DLT groups. We conclude that R-DLTs can be used for left-sided thoracic surgery without an increased risk of right upper-lobe collapse. Our data suggest that R-DLTs may be more prone to intraoperative dislodgment/malposition than L-DLTs; however, in all cases, correction of malposition was easily achieved. IMPLICATIONS: In this study, right-sided double-lumen tubes (R-DLTs) were compared with modified left-sided double-lumen tubes in patients requiring one-lung ventilation for left-sided thoracic surgery. The incidence of right upper-lobe collapse was assessed intraoperatively by a chest radiograph which showed no collapse of the right upper lobe in all patients who received R-DLTs or left-sided double-lumen tubes. Therefore, we conclude that R-DLTs present no increased risk of complications for left-sided thoracic surgery and should not be abandoned.

A reaction to tape after tracheal extubation in a patient with systemic amyloidosis.

A reaction to tape after tracheal extubation in a patient with systemic amyloidosis is reported. A patient underwent a right thoracotomy with general anesthesia. A double-lumen tube secured with 1-inch adhesive tape (3M Blenderm, 3M Health Care, St Paul, MN) was used. The same kind of tape was used to cover the eyelids. On removal of the tape, hemorrhagic and purpuric lesions appeared on the skin in regions corresponding to the tape contact area. A diagnosis of amyloidosis was made based on large tongue, lip edema, purpuric and hemorrhagic spots on the skin, congestive heart failure, and skin biopsy. Amyloidosis and its anesthetic implications are discussed.

Failure of buparvaquone (Butalex) in the treatment of canine visceral leishmaniosis.

Buparvaquone (Butalex), a therapeutic for theileriosis, has been shown to have anti-leishmanial activity in vitro. Seven dogs with symptomatic, parasitologically positive, canine visceral leishmaniosis were treated with Butalex at 5 mg kg(-1) body weight using four doses over 12 days. Two animals showed minor clinical improvement (growth of healthy hair) but all remained parasitologically positive and disease progression was not halted.

Clinical recovery and limited cure in canine visceral leishmaniasis treated with aminosidine (paromomycin).

Three groups of three, six, and 12 dogs with parasitologically proven clinical visceral leishmaniasis (Leishmania chagasi infection) were treated with intramuscular aminosidine sulfate at doses of 20 mg/kg/day for 15 days; 80 mg/kg/day for 20 days, and 40 mg/kg/day for 30 days, respectively. Follow-up was by parasitologic examination of bone marrow and skin, serology using the indirect immunofluorescent antibody test, and clinical examination for signs of visceral leishmaniasis or adverse effects of treatment. In animals treated with 20 mg/kg/day, for 15 days, there was dramatic clinical improvement with disappearance of conjunctivitis, increase in appetite, weight gain, and recovery of normal skin condition and a healthy coat, but parasitologic relapse occurred between 50 and 100 days after initiation of treatment. Adverse effects were seen with treatment with 80 mg/kg/day for 20 days; three dogs died during or just after treatment, two showed temporary recovery, and one showed total clinical and parasitologic cure that was maintained for four years. Although adverse effects and relapses were seen in some dogs treated with 40 mg/kg/day for 30 days, three of 12 dogs showed complete parasitologic and clinical cure that was sustained for at least four years. Aminosidine treatment cannot be recommended as an alternative to the humane destruction of dogs for the control of canine visceral leishmaniasis because ineffective treatment may prolong carrier status or encourage development of drug resistance. This drug may be a therapeutic option if there is no danger of a dog acting as a reservoir of infection. Achievement of clinical recovery and limited cure with aminosidine suggests that further trials would be of value, possibly in combination with other anti-leishmanial drugs and with supportive measures to reduce adverse effects.

Is there a better right-sided tube for one-lung ventilation? A comparison of the right-sided double-lumen tube with the single-lumen tube with right-sided enclosed bronchial blocker.

UNLABELLED: Anatomic variation between tracheal carina and the take-off of the right upper bronchus often makes the use of a right-sided double-lumen tube (R-DLT) or a single-lumen tube with right-sided enclosed bronchial blocker tube (R-UBB) (Univent) undesirable. This study compared the R-DLT with the R-UBB to determine whether there was any advantage of one over the other during anesthesia with one-lung ventilation (OLV) for right-sided thoracic surgeries. Forty patients requiring right lung deflation were randomly assigned to one of two groups. Twenty patients received a right-sided BronchoCath double-lumen tube, and 20 received a Univent tube with a bronchial blocker placed in the right mainstem bronchus. The following were studied: 1) time required to position each tube until satisfactory placement was achieved; 2) number of times that fiberoptic bronchoscopy was required (including one with the patient supine and one in lateral decubitus position); 3) number of malpositions after initial confirmation of tube placement; 4) time required until lung collapse; 5) surgical exposure; and 6) cost of tubes per case. No differences were found with any of these variables except that the cost of acquisition overall was greater for the R-UBB than for the R-DLT. No right upper lobe collapse was observed in the postoperative period in the chest radiograph in any of the patients studied. We conclude that either tube can be used safely and effectively for right-sided thoracic surgeries that require anesthesia for OLV. IMPLICATIONS: In this study, right-sided double-lumen tubes were compared with the Univent with right-sided bronchial blockers. The results indicate that either tube can be used for right-sided thoracic surgery.

Effects of oxygenation during selective lobar versus total lung collapse with or without continuous positive airway pressure.

UNLABELLED: Hypoxemia is common during anesthesia with one-lung ventilation (OLV). This study tested the hypothesis that selective lobar blockade would result in higher PaO2 values compared with those found with total lung collapse independent of continuous positive airway pressure (CPAP) application. Thirty patients undergoing lobectomy were randomly assigned to one of four groups with the following maneuvers during OLV: Group 1 (n = 8) total lung collapse (TLC) plus 5 cm H2O of CPAP to the nonventilated operative lung for 15 mins, followed by selective lobe collapse plus 5 cm H2O of CPAP (during selective collapse only the surgical lobe was collapsed and the rest of that lung was ventilated); Group 2 (n = 6) selective lobar collapse plus 5 cm H2O of CPAP to the operative lung, followed by TLC plus 5 cm H2O of CPAP; Group 3 (n = 8) total lung collapse without CPAP, followed by selective lobe collapse and no CPAP; Group 4 (n = 8) selective lobe collapse without CPAP, followed by TLC and no CPAP. To obtain selective lobe collapse, the bronchial blocker of the Univent (Vitaid, Lewiston, NY) endotracheal tube was guided into the operative bronchus with the aid of a fiberoptic bronchoscope. Blood pressure, heart rate, and arterial blood gas measurements were obtained during the following times: Time 1--while the patient was awake; Time 2--two-lung ventilation (2LV) in the supine position; Time 3--after 30 min of OLV in the lateral decubitus position (no CPAP or selective blockade); Time 4 and Time 5--during maneuvers described above (see group description); Time 6--2LV resumed; Time 7--30 min after extubation. Twenty-eight patients completed the study. There were no differences among groups with regard to arterial blood pressure, heart rate, or arterial oxygen saturation during the experimental maneuvers. All four groups showed a decrease in PaO2 from 2LV to OLV (P < 0.05). Both with and without CPAP application, oxygenation was improved with selective lobe collapse compared with TLC. When selective lobe collapse with 5 cm H2O of CPAP followed TLC (group 1), PaO2 values increased to values similar to those found for 2LV (PaO2 449 +/- 122 vs 394 +/- 105 mm Hg). This study indicates that by using a bronchial blocker, changing from total lung collapse to selective lobar blockade improves PaO2 during lung surgery. IMPLICATIONS: This study examines how oxygen tension in arterial blood can be higher during one-lung ventilation. The use of a bronchial blocker, which changes a total lung collapse to selective lobar blockade, improves oxygenation during lung surgery.

Comparison of a modified double-lumen endotracheal tube with a single-lumen tube with enclosed bronchial blocker.

This study compared the modified BronchoCath double-lumen endotracheal tube with the Univent bronchial blocker to determine whether there were objective advantages of one over the other during anesthesia with one-lung ventilation (OLV). Forty patients having either thoracic or esophageal procedures were randomly assigned to one of two groups. Twenty patients received a left-side modified BronchoCath double-lumen tube (DLT), and 20 received a Univent tube with a bronchial blocker. The following were studied: 1) time required to position each tube until satisfactory placement was achieved; 2) number of times that the fiberoptic bronchoscope was required; 3) frequency of malpositions after initial placement with fiberoptic bronchoscopy; 4) time required until lung collapse; 5) surgical exposure ranked by surgeons blinded to type of tube used; and 6) cost of tubes per case. No differences were found in: 1) time required to position each tube (DLT 6.2 +/- 3.1 versus Univent 5.4 +/- 4.5 min [mean +/- SD]); 2) number of bronchoscopies per patient (DLT median 2, range 1-3 versus Univent median 3, range 2-5); or 3) time to lung collapse (DLT 7.1 +/- 5.4 versus Univent 12.3 +/- 10.5 min). The frequency of malposition was significantly lower for the DLT (5) compared to the Univent (15) (P < 0.003). Blinded evaluations by surgeons indicated that 18/20 DLT provided excellent exposure compared to 15/20 for the Univent group (P = not significant). We conclude that in spite of the greater frequency of malposition seen with the Univent, once position was corrected adequate surgical exposure was provided. In the Univent group the incidence of malposition and cost involved were both sufficiently greater that we cannot find cost/ efficacy justification for routine use of this device.

Visceral leishmaniasis in Teresina, state of Piauí, Brazil: preliminary observations on the detection and transmissibility of canine and sandfly infections

A Leishmania donovani-complex specific DNA probe was usedto confirm the widespread dissemination of amastigotes in apparently normal skinof dogs with canine visceral leishmaniasis. When Lutzomyia longipalpis were fed on abnormal skin of five naturally infected dogs 57 of 163 (35 per cent) fliesbecame infected: four of 65 flies (6 per cent) became infected when fed on apparently normal skin. The bite of a single sandfly that had fed seven days previouslyon a naturally infected dog transmitted the infection to a young dog from a non-endemic area. Within 22 days a lesion had developed at the site of the infectivebite (inner ear): 98 days after infection organisms had not disseminated throughout the skin, bone marrow, spleen or liver and the animal was still serologically negative by indirect immunofluorescence and dot-enzyme-linked immunosorbent assay. When fed Lu. longipalpis were captured from a kennel with a sick dog known to be infected, 33 out of 49 (67 per cent) of flies contained promastigotes. In contrast only two infections were detected among more than 200 sandflies captured in houses. These observations confirm the ease of transmissibility of L.chagasi from dog to sandfly to dog in Teresina. It is likely that canine VL is the major source of human VL by the transmission route dog-sandfly-human. the Lmet2 DNA probe was a useful epidemiological tool for detecting L. chagasi in sandflies

Visceral leishmaniasis in Teresina, State of Piauí, Brazil: preliminary observations on the detection and transmissibility of canine and sandfly infections.

A Leishmania donovani-complex specific DNA probe was used to confirm the widespread dissemination of amastigotes in apparently normal skin of dogs with canine visceral leishmaniasis. When Lutzomyia longipalpis were fed on abnormal skin of five naturally infected dogs 57 of 163 (35%) flies became infected: four of 65 flies (6%) became infected when fed on apparently normal skin. The bite of a single sandfly that had fed seven days previously on a naturally infected dog transmitted the infection to a young dog from a non-endemic area. Within 22 days a lesion had developed at the site of the infective bite (inner ear): 98 days after infection organisms had not disseminated throughout the skin, bone marrow, spleen or liver and the animal was still serologically negative by indirect immunofluorescence and dot-enzyme-linked immunosorbent assay. When fed Lu. longipalpis were captured from a kennel with a sick dog known to be infected, 33 out of 49 (67%) of flies contained promastigotes. In contrast only two infections were detected among more than 200 sandflies captured in houses. These observations confirm the ease of transmissibility of L. chagasi from dog to sandfly to dog in Teresina. It is likely that canine VL is the major source of human VL by the transmission route dog-sandfly-human. The Lmet2 DNA probe was a useful epidemiological tool for detecting L. chagasi in sandflies.

Preliminary observations on the diagnosis and transmissibility of canine visceral leishmaniasis in Teresina, n.e. Brazil.

A pilot group of 49 dogs and control groups from non-endemic areas were examined serologically for the presence of visceral leishmaniasis (VL) by direct agglutination test (DAT), indirect immunofluorescence (IFAT) enzyme-linked immunosorbent assay (ELISA) and DOT-ELISA. Results indicated that DAT is less sensitive than the other assays and that serology with filter paper blood samples is less sensitive than with serum. Promastigote infections were common in fed Lutzomyia longipalpis taken from a dog kennel inhabited by a dog carrying Leishmania chagasi. Colony-bred Lu. longipalpis readily acquired L. chagasi infection when fed on skin lesions of dogs naturally infected with L. chagasi: a small proportion of flies also became infected when fed on apparently normal skin. Widespread distribution of amastigotes in normal skin of asymptomatic animals was shown both by intensive microscopy and by probing skin biopsy samples with the Lmet2 L. donovani-complex specific DNA probe. It was demonstrated that an immunologically naive dog could be infected by a single experimentally infected sand fly. Abundant amastigotes present within the resultant lesion 22 days later were transmissible to sand flies but serology remained negative at least 45 days after the infective bite. Experimental transmission of canine VL by sand fly bite is a valuable approach for determining which diagnostic procedures are most sensitive, specific and suitable for field application in suburban households.