Effects of changes in power setting of an ultrasonic aspirator on amount of damage to the cerebral cortex of healthy dogs.

OBJECTIVE: To determine the minimal ultrasonic aspirator pressure necessary to damage the cerebral cortex of healthy dogs. ANIMALS: 9 mixed-breed dogs. PROCEDURE: The study comprised 2 parts. In part A, 6 dogs were euthanatized immediately prior to the experiment. In part B, 3 dogs were anesthetized for recording of physiologic variables. In both parts, craniectomy and durotomy were performed to bilaterally expose the lateral aspect of the cerebral cortex. An ultrasonic aspirator was placed in contact with various areas of the cerebral cortex, and aspirator power was altered (10, 20, 30, and 40%). Duration of contact at each power was 5 and 10 seconds. Subsequently, gross morphologic and histologic damage was assessed in the cortex. RESULTS: Gross observations for all dogs were similar. At 10% power, visible or histologic damage was not evident in the cortex. At 20% power, the cortex was slightly indented from contact with the hand piece; however, cortical disruption was not evident. Cortical disruption was initially detectable at 30% power in some dogs and was consistently evident at 40% power in both sets of dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Ultrasonic aspirator power of < 20% created minimal acute morphologic damage to the cortex. Power settings between 20 and 30% may superficially damage the cerebral cortex in healthy dogs, whereas 40% power consistently damages the cerebral cortex. Knowledge of the degree of damage to cerebral cortex caused by various amounts of power for ultrasonic aspirators will allow surgeons to avoid damaging normal brain tissues during surgery.

Clinical signs associated with brain tumors in dogs: 97 cases (1992-1997).

OBJECTIVE: To determine the prevalence of various clinical signs in dogs with brain tumors. DESIGN: Retrospective study. ANIMALS: 97 dogs with brain tumors. PROCEDURE: Medical records were reviewed for signalment, tumor type and location, and clinical signs. RESULTS: 33 breeds were represented; Golden Retrievers were most commonly affected. Most dogs were older (median age, 9 years); 95% of dogs were > or = 5 years old. Seventy-six percent of dogs had tumors in the supratentorial region. Seizures were the most common clinical sign at initial examination, with lower prevalence for circling, ataxia, and head tilt. Meningioma was the most common tumor. CONCLUSIONS AND CLINICAL RELEVANCE: Brain tumors develop most often in dogs > or = 5 years old and are uncommon in dogs < 5 years old. Seizures are a common clinical sign, and a brain tumor should be considered in dogs that have their first seizure after they are 4 years old.

Realignment of a seventh lumbar vertebral fracture/luxation using a Senn retractor in two puppies.

Two puppies, each with fractures of the seventh lumbar (L7) vertebra, had their vertebral canals aligned surgically with the aid of a Senn retractor. The retractor was used to provide leverage during vertebral manipulations. Surgical fixation was achieved using Steinmann pins and polymethylmethacrylate. Both puppies were improved immediately after surgery and were clinically normal six months after surgery.

Acute, unilateral transverse sinus occlusion during craniectomy in seven dogs with space-occupying intracranial disease.

OBJECTIVE: The purpose of this study was to determine the effect of acute, unilateral transverse sinus occlusion on intracranial pressure (ICP) and postoperative mortality in dogs with structural intracranial disease. STUDY DESIGN: Affected dogs had a single transverse sinus occluded during craniectomy for intracranial mass biopsy or removal. ANIMALS: Seven dogs with space-occupying intracranial disease in the cerebellopontine angle area. METHODS: The ipsilateral transverse sinus was permanently occluded during the surgical approach to the intracranial lesion to increase surgical exposure by allowing a caudal lateral rostrotentorial craniectomy to be combined with a suboccipital craniectomy. In five dogs, intracranial pressure was monitored during surgery using a fiberoptic intracranial pressure monitoring device. RESULTS: Initial ICP varied among dogs, ranging from 7 to 21 mm Hg. Intracranial pressure, however, decreased in all dogs after craniectomy and durotomy (P < .05). No increase in intracranial pressure occurred after transverse sinus occlusion (P = .42). All dogs survived the surgical procedure. CONCLUSIONS: Acute, unilateral transverse sinus occlusion during craniectomy in dogs with space-occupying intracranial lesions did not result in significant increases in ICP or intraoperative mortality. CLINICAL RELEVANCE: Acute, unilateral transverse sinus occlusion during craniectomy can be used to increased surgical exposure to the caudal fossa of the brain without increased risk of increasing ICP.

Suspected herbicide toxicosis in a dog.

An 8-year-old 38-kg spayed female Golden Retriever was admitted for vomiting, signs of abdominal pain on palpation, ataxia, anorexia, and generalized weakness of 2 days' duration. Ten hours prior to onset of clinical signs, the dog was found standing in and drinking from large pools of an accidentally spilled herbicide that contained an octanoic acid ester of bromoxynil (3,5-dibromo-4-hydroxybenzonitrile) and an isooctyl ester of (2-methyl-4-chloro) phenoxyacetic acid (MCPA). Appendicular muscles were firm on palpation and persistent muscle contraction (myotonia > 1 minute duration) was found on muscle percussion, using a reflex hammer. Electrical activity indicative of myotonia was identified on electromyographic evaluation. With supportive treatment, the dog eventually recovered from suspected MCPA toxicosis. Although rare, MCPA toxicosis should be considered as a cause of acquired myotonia in dogs.

Effect of craniectomy, durotomy, and wound closure on intracranial pressure in healthy cats.

OBJECTIVES: To establish intracranial pressure (ICP) measurements in healthy cats under isoflurane anesthesia, using a fiberoptic monitoring system; to assess brain lesions associated with such monitoring; and to determine whether decompressive intracranial surgery decreases ICP in healthy cats. ANIMALS: 6 healthy cats. PROCEDURE: Craniectomy and durotomy were performed, and the effect of these procedures on ICP was determined. ICP was monitored by use of a fiberoptic monitoring system. Gross and microscopic evaluations of brain tissues were performed after data collection. RESULTS: ICP decreased significantly after craniotomy and durotomy. After wound closure, ICP remained significantly reduced relative to initial pressures. However, postsurgical pressures were significantly increased, compared with those associated with ICP after durotomy. Gross and histologic abnormalities associated with placement of the ICP monitoring cable included mild focal acute hemorrhage and mechanical cortical disruption. CONCLUSIONS: Craniectomy and durotomy significantly decreased ICP in healthy cats. ICP increased after wound closure, but remained significantly lower than initial pressures. CLINICAL RELEVANCE: Craniectomy and durotomy may be used to decrease ICP in cats.

Identification and treatment of children's mental health problems by primary care providers: a critical review of research.

This article critically reviews research studies on the identification and treatment of children's mental health problems by primary care providers. Using a valid and reliable instrument to guide the review, the investigators examined the methods and findings of all 13 studies published on the topic from 1979 to 1994. Overall, primary care providers appeared to underidentify mental health problems among children and adolescents, especially those whose emotional impairments were not overtly severe. Large proportions of youngsters identified as having mental health problems did not receive needed treatment.

Intracranial tumors.

Intracranial tumors in dogs are relatively common but are less common in cats. Features of various tumors are described. The antemortem diagnosis is based on demonstrating the mass with advanced imaging. Tumor type, however, can only be diagnosed by histological confirmation. Diagnosis and treatment options are discussed.

Surgical treatments for seizure. Adaptability for dogs.

Surgical treatments are often used for human epileptics who are refractory to more conventional anticonvulsant therapies. The goals of surgery are to decrease seizure morbidity or, ideally, bring about a cure to the seizure disorder. As a sizable subpopulation of dogs with seizures are also refractory to currently available anticonvulsant therapies, consideration has been given to evaluating alternative treatments for seizures in dogs. This article discusses the adaptability of surgical treatments used in humans for use in seizure control in affected dogs.

Hydrocephalus.

Hydrocephalus may be an acquired or congenital condition. Clinical signs often reflect the level of brain involvement. In young dogs, the presence of a dome-shaped head and/or persistent fontanel are suggestive of hydrocephalus. Ventriculoperitoneal shunting is often used for definitive treatment of hydrocephalus.

Effect of craniectomy/durotomy alone and in combination with hyperventilation, diuretics, and corticosteroids on intracranial pressure in clinically normal dogs.

OBJECTIVE: To determine the effect of craniectomy and durotomy on intracranial pressure (ICP) in clinically normal dogs. DESIGN: Two-part study (experiments A and B) involving craniectomy and durotomy, with and without treatments to lower ICP. ANIMALS: Six (experiment A) and 7 (experiment B) healthy dogs. PROCEDURE: In experiment A, craniectomy was performed in combination with durotomy, diuretic administration, methylprednisolone sodium succinate administration, and hyperventilation, and effect of these manipulations on ICP was determined. In experiment B, dogs had only craniectomy and durotomy without associated ICP-lowering treatments. During both experiments, ICP was monitored throughout the surgical procedure with a fiber optic ICP monitoring device. RESULTS: Intracranial pressure decreased after the combination of craniectomy, durotomy, and other ICP-lowering treatments in dogs of experiment A. Similar magnitude of decrease in ICP was observed in dogs of experiment B after craniectomy and durotomy. CONCLUSIONS: Comparison of these experiments indicate that surgical removal of overlying skull and incision of the dura mater can significantly decrease ICP in clinically normal dogs. CLINICAL RELEVANCE: Craniectomy and durotomy may be useful as an adjunct treatment for increased ICP.

Barriers to the use of preventive health care services for children.

This article describes findings from interviews of parents targeted for outreach efforts that encouraged them to use Medicaid's Early and Periodic Screening, Diagnosis and Treatment(EPSDT) Program. Begun in the 1970s, the EPSDT program held out the promise of ensuring that needy children would receive comprehensive preventive care. With only one-third of eligible children in the United States receiving EPSDT checkups, the program has yet to fulfill its promise. This study sought to understand parents' perceptions of barriers to using EPSDT by interviewing (a) 110 parents who did not schedule EPSDT checkups for their children after being exposed to outreach efforts and (b) 30 parents who did. Although the EPSDT Program is designed to provide health care at no charge and to provide assistance with appointment scheduling and transportation, these low-income parents identified significant barriers to care. Reasons for not using EPSDT services included (a) competing family or personal issues and priorities; (b) perceived or actual barriers in the health care system; and (c) issues related directly to problems with the outreach efforts. Parents who successfully negotiated these barriers and received EPSDT services encountered additional barriers, for example, scheduling and transportation difficulties, long waiting room times, or care that they perceived to be either unresponsive to their medical needs or interpersonally disrespectful. The implications for future outreach efforts and improving access to preventive health care services are discussed.

Diversity in the rural poor: differences between households with and without telephones.

Differences between households with and without phones in the United States as a whole are well documented, but these differences, and their implications for nursing practice and research, have received little attention in nursing publications. This article 1) reviews findings from national studies of these differences and 2) reports on a nursing study that examined such differences specifically in a random sample (N = 2,053) of low-income families having children eligible for but not using the well-child services of the Medicaid program in rural North Carolina. The study was part of a randomized trial of nursing interventions to encourage parents to use these services. The analyses reported herein focus on how families with and without phones differed in health-related characteristics and in responses to the interventions. The findings have relevance for public health nurses conducting outreach or research with similar low-income families, even when the outreach or research methods do not involve phone contact.

Pathologic effects in brain after intracranial pressure monitoring in clinically normal dogs, using a fiberoptic monitoring system.

During 2 separate studies, intracranial pressure (ICP) was measured in 13 healthy dogs (group A, n = 7; group B, n = 6), using a fiberoptic monitoring system implanted surgically in the right superficial cerebral cortex. Average ICP was measured for 15 minutes after a 15-minute postimplantation period of equilibration. Intracranial pressure was measured in group-A dogs at 2.0 and 1.3% end-tidal isoflurane concentrations. Mean +/- 1 SD ICP in group-A dogs at 2.0 and 1.3% end-tidal isoflurane concentrations was 11 +/- 2 and 11 +/- 3 mm of Hg, respectively. Dogs of group A were euthanatized immediately after measurements were obtained. Mean ICP +/- 1 SD in group-B dogs was 11 +/- 3 mm of Hg. After monitoring, but prior to euthanasia, group-B dogs underwent callosotomy, and were maintained for 30 days after surgery. The brain was removed from all dogs, formalin fixed, and examined grossly and microscopically for lesions associated with fiberoptic cable implantation. Variable degrees of hemorrhage and mechanical brain damage were seen focally around the catheter site in all brains from group-A dogs, especially when the cable entered through a sulcus. In 1 dog, local vacuolation was seen in the brain immediately adjacent to the tract associated with implantation of the fiberoptic catheter. In all other dogs, the additional cortex was histologically normal. Histologic lesions associated with cable implantation were not observed in group-B dogs.

The early and periodic screening, diagnosis and treatment program: opportunities for nurse practitioners.

The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program is intended to provide comprehensive preventive health care services for children and young adults from low-income families on Medicaid. Unfortunately, only a fraction of the individuals eligible for care actually receive EPSDT services, often because of a shortage of providers who offer these services. Nurse practitioners are ideally suited to offer such services and, in states where they are allowed to function independently, can receive direct Medicaid reimbursement for them. Because many nurse practitioners are unfamiliar with the EPSDT program, this article describes the key components of the program and explains how nurse practitioners can provide EPSDT services.

Obtaining telephone numbers for a rural Medicaid population: issues for outreach and research.

This study examined the accuracy and costs of determining whether rural, low-income Medicaid recipients did or did not have a phone, and of obtaining phone numbers for those who did. For a random sample of 209 families, we compared phone information obtained from phone books and directory assistance with information obtained from department of social services (DSS) records. DSS records identified 51% of the sample as having phones, compared with 19%-25% for phone books and directory assistance. For identifying families as having no home phone or a phone with a number that matched the one in the DSS record, phone books or directory assistance corresponded with DSS records in 52%-57% of the sample. Using phone books or directory assistance was up to 3.2 times more costly than using DSS records. The study highlighted the need to establish policies to promote the exchange of information between social services and public health agencies and researchers.

Clinical effects of longitudinal division of the corpus callosum in normal dogs.

Longitudinal division of the corpus callosum was performed in six normal beagles to determine surgical morbidity. The corpus callosum was divided sagittally on the midline and the effect on neurological function was determined. Five of six dogs were clinically normal within 14 days or less after surgery. One dog had persistent but improving clinical signs consistent with a forebrain disturbance at 30 days after surgery. Overall, minimal morbidity and no mortality was associated with this surgical procedure. Further study is indicated to determine the efficacy of this surgical treatment for seizure control in dogs with idiopathic epilepsy.

Comprehensiveness of well child checkups for children receiving Medicaid: a pilot study.

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) is a Medicaid program designed to provide comprehensive well child care for children from low-income families. Each EPSDT checkup should include a physical examination; medical history; assessment of development, nutrition, and immunizations; assessment of hearing, vision, and dental status; and anticipatory guidance. This pilot study of the medical records of 76 children receiving EPSDT checkups in six rural counties in North Carolina provided a preliminary assessment of whether EPSDT checkups included the required components. The study showed that health care providers frequently did not provide adequate documentation of the care provided at the checkup, and it raised questions as to whether children received the required components of the EPSDT checkup.

Communicating research findings to readers of clinical nursing journals: guidance for prospective authors.

The dissemination of research through publication in professional journals is important for the advancement of pediatric nursing practice. Without knowledge of current research, practitioners cannot take actions to apply research to improve the health of the children and families they serve. To ensure that practitioners can make the most appropriate use of quantitative research findings, research publications must adhere to specific scientific standards for the conduct and reporting of research. This article is intended to guide nurse researchers to adhere to these standards and effectively communicate their research findings to nurses in clinical practice.