Outcome of SUB placement for the treatment of benign ureteral obstruction in dogs: nine dogs and 12 renal units (2013 to 2017).

OBJECTIVES: To describe a group of dogs with benign ureteral obstruction(s) treated by subcutaneous ureteral bypass and report the intra-operative, peri-operative, short- and long-term outcomes. MATERIALS AND METHODS: Review of medical records of dogs that underwent subcutaneous ureteral bypass. RESULTS: Nine dogs (12 renal units) were included. Causes of obstruction included: ureterolithiasis (n=9) extraluminal compression (n=2), and stricture (n=1). Eleven of 12 ureters had a previously placed stent and required subcutaneous ureteral bypass for: recurrent stricture (n=4), diffuse ureteritis (n=4) or stent migration (n=3). Placement was successful in all renal units and there were no peri-operative or procedure-related deaths. Median hospitalisation time was 3 days. The median creatinine values pre-operatively and 3 month post-operatively were 186 and 106 µmol/L, respectively. No dog had worsening azotaemia in the short-term. The most common long-term complication was mineralisation of six devices, of which four required exchange. All dogs that were infected post-operatively (n=5) had a history of at least one urinary tract infection pre-operatively. One of the nine dogs had a chronic post-operative urinary tract infection and had been chronically infected before placing the bypass. The median survival time was >774 days, with five of nine dogs alive at the time of publication. CLINICAL SIGNIFICANCE: Placement of a subcutaneous ureteral bypass was an effective short-term treatment option for benign ureteral obstructions in dogs but there was a high rate of device mineralisation.

A double vacuum window mechanism for space-borne applications.

We present a vacuum window mechanism that is useful for applications requiring two different vacuum windows in series, with one of them movable and resealable. Such applications include space borne instruments that can benefit from a thin vacuum window at low ambient pressures but must also have an optically open aperture at atmospheric pressures. We describe the implementation and successful operation with the E and B experiment balloon-borne payload, a millimeter-wave instrument designed to measure the polarization of the cosmic microwave background radiation.

Effects of two wattages of low-level laser therapy on orthodontic tooth movement.

INTRODUCTION: Mixed outcomes have been found in animal and clinical studies with regard to the use of low-level laser therapy (LLLT) as a modality to accelerate orthodontic tooth movement (OTM). One major reason for the variable findings is the different methodologies and protocols for laser therapy use. OBJECTIVE: The aim of this study was to determine whether orthodontically moved molars exposed to two different wattages at the same energy density of LLLT exhibited differences in the amount of tooth movement and molecular and histological changes in the adjacent periodontal areas. METHODS: An orthodontic force was applied to rat upper first molars exposed to 500mW (EX-500) and 1000mW (EX-1000) of laser application, with a control group (CT) with no laser application. Gene expression in the periodontal ligament (PDL) and histology of the palatal gingiva of the molars were analyzed. RESULTS: There was a statistically significant difference for OTM between EX-500 but not between EX-1000 and CT groups. RANKL and MMP-13 expression levels in the PDL of orthodontically moved molars, however, were increased significantly in laser-exposed groups compared to CT. Early signs of dysplasia were observed in over half of the animals in the EX-1000 group. CONCLUSIONS: Our results provide evidence for molecular changes and the potential dysplastic effects of laser on the surrounding soft tissues. Further studies are needed to better identify an optimum laser protocol to maximize the desired effect.

The vesicular monoamine transporter (VMAT-2) inhibitor tetrabenazine induces tremulous jaw movements in rodents: implications for pharmacological models of parkinsonian tremor.

Tetrabenazine (TBZ) is a reversible inhibitor of vesicular monoamine storage that is used to treat Huntington's disease. TBZ preferentially depletes striatal dopamine (DA), and patients being treated with TBZ often experience parkinsonian side effects. The present studies were conducted to investigate the ability of TBZ to induce tremulous jaw movements (TJMs), which are a rodent model of parkinsonian tremor, and to determine if interference with adenosine A2A receptor transmission can attenuate TJMs and other motor effects of TBZ. In rats, TBZ (0.25-2.0mg/kg) significantly induced TJMs, which primarily occurred in the 3.0-7.5-Hz frequency range. The adenosine A2A antagonist MSX-3 (1.25-10.0mg/kg) significantly attenuated the TJMs induced by 2.0mg/kg TBZ in rats, and also significantly reduced the display of catalepsy and locomotor suppression induced by TBZ. In mice, TBZ (2.5-10.0mg/kg) dose dependently induced TJMs, and adenosine A2A receptor knockout mice showed significantly fewer TJMs compared to wild-type controls. MSX-3 (2.5-10.0mg/kg) also significantly reduced TBZ-induced TJMs in CD1 mice. To provide a cellular marker of these pharmacological conditions, we examined c-Fos expression in the ventrolateral neostriatum (VLS). TBZ (2.0mg/kg) significantly increased the number of c-Fos-positive cells in the VLS, which is indicative of reduced DA D2 receptor transmission, and 10.0mg/kg MSX-3 significantly attenuated the TBZ-induced c-Fos expression. These results indicate that TBZ induces tremor as measured by the TJM model, and that pharmacological antagonism and genetic deletion of adenosine A2A receptors are capable of attenuating this oral tremor.

The disposition of lidocaine during a 12-hour intravenous infusion to postoperative horses.

Lidocaine is administered as an intravenous infusion to horses for a variety of reasons, but no study has assessed plasma lidocaine concentrations during a 12-h infusion to horses. The purpose of this study was to evaluate the plasma concentrations and pharmacokinetics of lidocaine during a 12-h infusion to postoperative horses. A second purpose of the study was to evaluate the in vitro plasma protein binding of lidocaine in equine plasma. Lidocaine hydrochloride was administered as a loading dose, 1.3 mg/kg over 15 min, then by a constant rate IV infusion, 50 microg/kg/min to six postoperative horses. Lidocaine plasma concentrations were measured by a validated high-pressure liquid chromatography method. One horse experienced tremors and collapsed 5.5 h into the study. The range of plasma concentrations during the infusion was 1.21-3.13 microg/mL. Lidocaine plasma concentrations were significantly increased at 0.5, 4, 6, 8, 10 and 12 h compared with 1, 2 and 3 h. The in vitro protein binding of lidocaine in equine plasma at 2 microg/mL was 53.06+/-10.28% and decreased to 27.33+/-9.72% and 29.52+/-6.44% when in combination with ceftiofur or the combination of ceftiofur and flunixin, respectively. In conclusion, a lower lidocaine infusion rate may need to be administered to horses on long-term lidocaine infusions. The in vitro protein binding of lidocaine is moderate in equine plasma, but highly protein bound drugs may displace lidocaine increasing unbound concentrations and the risk of lidocaine toxicity.

Microwave endometrial ablation: patients' experiences in the first 3 months following treatment.

The aim of this study was to investigate patients' experiences in the first 3 months following microwave endometrial ablation (MEA) for menorrhagia as well as the suitability of local anaesthesia (LA) versus general anaesthesia (GA) for these procedures. We carried out a cross-sectional questionnaire survey of 173 patients at 3 months after treatment with MEA. All were treated between September 1997 and December 1999. The setting was a small free-standing hospital day unit equipped with a minor operating theatre. Interventions were pretreatment with danazol or goserelin, followed by endometrial ablation with microwaves under GA or LA. Of the 173 patients, 98 (57%) were treated under GA, and 75(43%) under LA. The return of questionnaires was high in both groups (90% for GA and 84% for LA) and all procedures were completed with the planned anaesthetic. Commonly reported symptoms were immediate postoperative pain (61%), abdominal pain in the following weeks (75%), vaginal discharge (87%), vaginal bleeding (74%) and vaginal dryness. Reported symptoms were usually mild and not requiring medical intervention, e.g. in 124 patients (71%), postoperative pain was either absent or mild with no analgesics required. Only 4% had severe pain requiring a single dose of opiate analgesia. The results were similar in both groups. Sixty-nine per cent (104 patients) had no pain 1 week after treatment. This increased to over 90% by the end of the third week. Results were similar in those treated under LA (83% and 96%, respectively). There was early return to normal daily activity (70% by 1 week and 95% by 3 weeks). Reported symptoms were usually mild and not severe enough to warrant consultation of their doctor or the hospital. There were no blood transfusions or hysterectomy within the first 3 months of treatment. We conclude that MEA is well tolerated by patients. Reported side effects are usually minor. LA is comparable to GA and seems to have potential benefits.

Enhanced airborne polychlorinated biphenyl (PCB) concentrations and chlorination downwind of Lake Ontario.

Air samples were collected simultaneously at three sites downwind of Lake Ontario and at a control site near Lake Erie from March to July of 1999. The Lake Erie site (Stockton, NY) had PCB concentrations similar to rural Integrated Atmospheric Deposition Network (IADN) sampling sites across the Great Lakes, exhibited limited seasonal variation, and approximates regional background. Samples taken along Lake Ontario's southeastern shore (Rice Creek and Sterling, NY) had elevated PCB concentrations averaging approximately 1 ng/m3 and were more chlorinated than air collected at IADN sites and at Stockton. Air samples from Potsdam (approximately 75 km inland) had similar concentrations but were less chlorinated. Clausius-Clapeyron plots revealed a strong correlation between PCB fugacity and temperature near Lake Ontario; however, the extent of chlorination of the air samples rules out volatilization from the lake as a major source. It is hypothesized that volatilization from local surfaces, enriched in higher chlorinated congeners by meteorological or geographic factors, drives both the concentration and composition of airborne PCBs along Lake Ontario's southeastern shore.

Uterine preservation or hysterectomy at sacrospinous colpopexy for uterovaginal prolapse?

This study retrospectively compared 34 women who had a sacrospinous hysteropexy and 36 who had a vaginal hysterectomy and sacrospinous fixation for symptomatic uterine prolapse. All women underwent independent review and examination, with a mean follow-up of 36 months in the hysterectomy group and 26 months in the hysteropexy group. The subjective success rate was 86% in the hysterectomy group and 78% in the hysteropexy group (P = 0.70). The objective success rate was 72% and 74%, respectively (P = 1.00). The patient-determined satisfaction rate was 86% in the hysterectomy group and 85% in the hysteropexy group (P = 1.00). The operating time in the hysterectomy group was 91 minutes, compared to 59 minutes in the hysteropexy group (P < 0.01). The mean intraoperative blood loss in the hysterectomy group was 402 ml, compared to 198 ml in the hysteropexy group (P < 0.01). The sacrospinous hysteropexy is effective in the treatment of uterine prolapse. Vaginal hysterectomy may not be necessary in the surgical treatment of uterine prolapse.

Current concepts of the actions of paracetamol (acetaminophen) and NSAIDs.

There is much uncertainty about the mechanism of action of paracetamol (acetaminophen). It is commonly stated that, unlike the non-steroidal anti-inflammatory drugs (NSAIDs), it is a weak inhibitor of the synthesis of prostaglandins. This conclusion is made largely from studies in which the synthesis of prostaglandins was measured in homogenized tissues. However, in several cellular systems, paracetamol is an inhibitor of the synthesis of prostaglandins with IC(50) values ranging from approximately 4 microM to 200 microM. Paracetamol is not bound significantly to plasma proteins and therefore the concentrations in plasma can be equated directly with those used in in vitro experiments. After oral doses of 1 g, the peak plasma concentrations of paracetamol are approximately 100 microM and the plasma concentrations are therefore in the range where marked inhibition of the synthesis of prostaglandins should occur in some cells. Paracetamol is metabolized by the peroxidase component of prostaglandin H synthase but the relationship of this to inhibition of the cyclooxygenase or peroxidase activities of the enzyme is unclear. Paracetamol is also metabolized by several other peroxidases, including myeloperoxidase, the enzyme in neutrophils which is responsible for the production of hypochlorous acid (HOCl). The metabolism of paracetamol by myeloperoxidase leads to the decreased total production of HOC1 by both intact neutrophils and isolated myeloperoxidase, even though the initial rate of production of HOC1 is increased. The IC(50) value, derived from inhibition of the total production of HOC1 by isolated myeloperoxidase, is 81 microM. Several NSAIDs inhibit functions of neutrophils in media containing low concentrations of protein but their effects, in contrast to that of paracetamol, are generally produced only at concentrations greater than those of the unbound drug in plasma during treatment with the NSAIDs. However, neutrophils isolated during treatment with NSAIDs, such as piroxicam, ibuprofen and indomethacin show decreased function. Paracetamol has little or no anti-inflammatory activity by itself but may potentiate the clinical activity of NSAIDs in the treatment of rheumatoid arthritis.

Microwave endometrial ablation for menorrhagia.

Sixteen women requesting surgical treatment of menorrhagia were recruited for a study on microwave endometrial ablation. The mean age at treatment was 41.4 years and all patients had completed their family and were pre-menopausal. Average treatment time was 2 minutes 6 seconds. All patients reported a reduction in their menstrual loss and 87.5% were satisfied with their treatment after 1 year follow-up. One patient required overnight admission for analgesia while 15 patients were treated on a day case basis using light general anaesthesia. Sixty-seven per cent of patients reported a reduction in dysmenorrhoea scores at 1 year, two patients reported no change in symptoms and one patient reported a modest increase. One patient had a hysterectomy 10 months after treatment despite being amenorrhoeic. The indication for hysterectomy was pelvic pain (which was present before endometrial ablation). There were few minor complications but no uterine perforation or emergency hysterectomies.

Testing the stress-response sequence model in paediatric oncology nursing.

The causes and intensity of role-related stress experienced by paediatric oncology nurses, the nurses' ability to respond to the stressors, and the professional and personal consequences of those stressors for the nurses are issues of concern for administrators and staff. The concern evolves from the anticipated relationships among stressors, the ability to cope with role-related stressors, and the expected negative outcomes such as resignation. However, the relationships among these components have not been previously measured concurrently in paediatric oncology nurses. The primary purpose of this study was to test the complete stress-response sequence model in a sample of paediatric oncology nurses by obtaining concurrent measures of the model's individual components: nurses' stressors, reactions, mediators, and consequences. A total of 126 nurses completed six questionnaires (Stressor Scale for Paediatric Oncology Nurses, Perceived Stress Scale, Measure of Job Satisfaction, Organized Commitment Questionnaire, Group Cohesion Scale, and Intent to Leave) and a demographic sheet. The majority of participating nurses were married, worked full-time and had worked 5 or more years in oncology. Qualitative data were analysed using a semantic content analysis technique. Relationships among the components of the model were examined using a two-stage least squares technique. The components were only weakly associated and unable to explain significant variation in each other. The combined qualitative and quantitative data indicate that an important explanatory variable - role-related meaning - is missing in the content model.

Peak and nadir experiences and their consequences described by pediatric oncology nurses.

Pediatric oncology nurses experience role-related stressors, some of which are inherent to the speciality, and their consequences. Despite these difficulties, nurses continue in the specialty. One variable that helps to explain their continued commitment is "meaning", or what pediatric oncology nurses find to be most significant and satisfying in their roles. One technique for determining meaning in a role is to inquire about the peak (significant and positive) and nadir (significant and negative) role-related experiences and the consequences of both kinds of experiences. The purpose of this study was to identify the peak and nadir experiences of pediatric oncology nurses and the short- and long-term consequences of those experiences. Using an interview format that consisted of four open-ended questions and a convenience sampling plan, five nurses interviewed 26 nurses from one pediatric cancer center and 38 nurses from a national sample. The interviewers completed an initial training session on interviewing and repeated that training two more times during data collection. Written or taped oral consent was obtained at the time of each interview. Using a content analytical technique (Krippendorff, 1980), four nurses independently coded each interview. Agreement ratings ranged from 75% to 100% per coded theme for an overall agreement level of 92%. Training for the coding process occurred initially and periodically throughout the analysis period. Fifteen different themes for peak experiences were identified, the majority of which reflect the nurses' experience with patients dying, or with patients recovering and living normal lives, or with the close relationships that develop between nurses and patients. Multiple short- and long-term consequences were identified and included changes in (1) values (becoming less judgmental), (2) behaviors (giving more empathic care), and (3) perspective (accepting limitations of care). Twenty-three different nadir themes were identified. A shared characteristic of several of these themes is the nurses' regret over a perceived inadequacy in handling a situation. Another common element is witnessing patient suffering and feeling unable to adequately relieve the suffering or provide comfort to the patient. The short-term consequences of nadir experiences tend to be negative and include guilt, anger, or dread. The long-term consequences tend to be positive and similar to the long-term consequences of peak experiences. Study findings indicate that pediatric oncology nurses do find meaning in their roles and that those who continue in the speciality are able to experience positive long-term consequences. Study findings will be used to develop a new scale to measure role-related meaning and to develop interventions designed to assist nurses in finding meaning in their roles even during particularly stressful periods.

The impact of a grief workshop for pediatric oncology nurses on their grief and perceived stress.

Coping with the death of a pediatric patient with whom the nurses has developed a close relationship is reported by nurses as the most stressful experience of being a pediatric nurse. Such losses are inevitable for a pediatric nurse regardless of subspecialty and can contribute to a nurse leaving the specialty or the discipline. To prevent those consequences, nurses' grief needs to be acknowledged, and their grieving needs to be facilitated. The purpose of this study was to determine the impact of a grief workshop on grief symptoms and perceived stress in two groups of pediatric oncology nurses who differed in years of experience in the specialty. Study findings indicated that the workshop affected the two groups differently, with the more experienced nurses reporting significantly higher stress levels after the workshop than did the less experienced nurses. Study findings are interpreted and recommendations for future work are offered.

A 20-year population-based study of postdiarrheal hemolytic uremic syndrome in Utah.

OBJECTIVE: To determine epidemiologic features, trends in frequency, and predictors of clinical outcome of postdiarrheal hemolytic uremic syndrome (HUS) in Utah. DESIGN: A 20-year population-based study of HUS with a review of the HUS registry, hospital records, transplant registry, and a survey of pediatricians and pediatric nephrologists to ensure completeness of ascertainment. POPULATION: All Utah residents under 18 years of age with HUS occurring after a diarrheal prodrome between 1971 and 1990. OUTCOME MEASURES: Incidence of HUS, severity, complications, and long-term sequelae. RESULTS: There were 157 cases during 20 years; 140 (89%) occurred after a diarrheal prodrome. The mean annual incidence was 1.42/100,000 children (range 0.2 to 3.4/100,000 children/year). Periods of high incidence occurred; however, there was no overall sustained increase in incidence. Escherichia coli O157:H7 was isolated from the stool of 62% of children who had specimens submitted. There were no differences between the first and second decade in the proportion with diarrheal prodrome, bloody diarrhea, most abnormal laboratory values, hospital course, or outcome. However, admission laboratory abnormalities were more severe during the first decade suggesting a delay in diagnosis. Age < 2 years, anuria before admission, and higher white blood cell counts on admission predicted severe disease. Bad outcome (death, end-stage renal disease, or stroke) occurred in 11%; 5% died. Chronic renal sequelae, usually mild, were found on follow-up (median 6.5 years) in 51% of survivors. CONCLUSIONS: HUS has been an important clinical and public health problem in Utah for 20 years. The consistency of the clinical and epidemiologic features over 2 decades suggests that a common etiologic agent has accounted for most cases of HUS in this region since 1971.

Association of skin wetness and pH with diaper dermatitis.

The strength of the association between diaper dermatitis and measurements of skin wetness and skin pH was evaluated by statistical analysis of four diaper trials involving 1601 infants. Although the strength of the association between skin wetness and diaper dermatitis was greater than that between skin pH and diaper dermatitis, increases in wetness and pH were both significantly associated with elevated mean grades for diaper dermatitis. The skin environment least likely to be associated with diaper dermatitis is one in which increases in both skin wetness and skin pH are minimized.