TTA-Rapid in the treatment of the canine cruciate deficient stifle: short- and medium-term outcome.

OBJECTIVES: To evaluate complications, short- and medium-term outcomes following treatment of lameness associated with cranial cruciate ligament insufficiency in dogs using the "TTA-Rapid" technique. METHODS: Patient records from two veterinary clinics were retrospectively examined to collect data from cases treated over a period of 21 months. An owner postal questionnaire using a clinical metrology instrument (Liverpool Osteoarthritis in Dogs) evaluated medium-term outcome of at least six months. RESULTS: In total 152 procedures were carried out in 141 dogs by two surgeons. Major complications, requiring further intervention, were identified in 11 (7%). Nine of these involved "late" meniscal injuries and two sustained tibial fractures postoperatively, one requiring internal fixation and the other external coaptation. The 3-month outcome was considered satisfactory in 99% of 135 procedures whilst the medium-term outcome (mean 16 months) was considered satisfactory in 86% of 108 dogs. CLINICAL SIGNIFICANCE: "TTA-Rapid" offers a treatment option for cranial cruciate-deficient stifles with good short- and medium-term outcomes. The complication rate was low in our hands.

Increasing the recognition of delirium in elderly patients.

OBJECTIVE: To determine if an educational intervention aimed at house staff will increase knowledge about and recognition of delirium. DESIGN: Before/after study, with blinding of participants to the intent of the study. SETTING: University hospital in Halifax, Nova Scotia. PATIENTS: One hundred eighty-seven control patients, seen as consecutive admissions of elderly patients (65 + years) to the General Medicine services of the Victoria General Hospital prior to the educational intervention, and 247 patients seen thereafter. INTERVENTION: Educational intervention at grand rounds, housestaff rounds, sign-in rounds, and bedside teaching. MEASUREMENTS: Recognition of delirium in the admitting history or progress notes, Confusion Assessment Method (CAM) as recorded by nurses, diagnosis of delirium by independent study physicians using DSM-IIIR criteria and the Trzepacz Delirium Symptom Rating Scale. RESULTS: Prior to the intervention, delirium or acute confusion was diagnosed in 3% of patients; after the intervention, delirium or acute confusion was diagnosed in 9% of patients (P < 0.01). Other abnormalities in mental state were noted in 8.5% of admissions prior to the intervention, and 15.6% of admissions after the intervention. After the intervention there was a significant difference in the proportion of patients in whom a mental status questionnaire had been carried out and in whom there was formal comment on various aspects of the mental state. The nursing CAM had a sensitivity of 0.68 and a specificity of 0.97. CONCLUSIONS: A simple educational intervention aimed at house staff appears to be effective in changing house staff behavior. Improved recognition of delirium may lead to better patient outcomes.

Interaction between thyroid hormones and erythrocyte membranes: competitive inhibition of binding 131 I-L-triiodothyronine and 131 I-L-thyroxine by their analogs.

Molecular structural characteristics of thyroid hormones which influence binding to the erythrocyte membranes were investigated by competitive binding experiments. The ability of thyroid hormone analogs to displace 131 I-L-thyroxine and 131 I-L-triiodothyronine from the membranes was considered evidence of their competitive binding. The diphenyl ether linkage (thyronine) was essential as compounds with a single aromatic ring were weakly competitive. The presence of three iodine atoms at 3, 5 and 3' positions on thyronine was optimal for maximal competitive binding. There was weak competitive binding of analogs if chlorine or bromine was substituted for iodine. The alanine side chain was required for optimal binding as N-acetyl-l-thyroxine and various deaminated analogs were poor competitors compared to T4 and T3. L-isomers of T4 and T3 showed greater competitive binding to erythrocyte membranes than the corresponding d-isomers.