[Iatrogenic anisocoria after using a scopolamine patch for PONV prophylaxis]. / Iatrogene Anisokorie nach Scopolaminpflaster zur PONV-Prophylaxe.

This is a case report of a 29-year-old female patient who developed unilateral mydriasis following the use of a scopolamine patch for the prevention of postoperative nausea and vomiting (PONV).Given a medical history showing multiple risk factors for PONV, a preauricular scopolamine patch was applied prior to the induction of anesthesia. General anesthesia was induced with 150 mg propofol and 25 µg sufentanil and maintained with total intravenous anesthesia, using propofol (5 mg/kg per h) and remifentanil (2-3 µg/kg per h).Following an uneventful surgery of 90min duration, the patient was extubated and transferred to the recovery room, where the patch was removed. During the orthopedic ward round the following day, the clinical examination revealed anisocoria of the left eye in the form of unilateral mydriasis. In order to determine the cause of this clinical presentation, further neurological and ophthalmological examinations and investigations were carried out. In addition, magnetic resonance imaging was conducted to rule out a central nervous cause. The results of the investigations were negative and no pathology was identified. In addition, the symptoms resolved within 24 h of onset without any therapeutic intervention. Therefore, a suspected diagnosis of a pharmacologically induced anisocoria from the scopolamine patch was made, whereby the substance accidentally reached the affected left eye.Previous studies showed that scopolamine patches may reduce early emetic symptoms. Case reports describing the occurrence of anisocoria following the application of scopolamine patches have been previously published. In all of these cases the patches were used to prevent PONV and each case was comprehensively investigated using various diagnostic and clinical tools. It should be noted, however, that a dysfunctional accommodation is listed as a common side effect of the drug, affecting more than 1 in 10 patients.Even though the efficacy of scopolamine patches for the prevention of PONV is proven, clinicians should be aware of the common ophthalmological side effect. Particularly with respect to various surgical disciplines, where anisocoria may indicate an underlying surgery-related complication, the application of scopolamine patches should be well- considered.

Postoperative delirium: why, what, and how to confront it at your institution.

PURPOSE OF REVIEW: The current article reviews the importance of postoperative delirium (POD), focusing on the older surgical population, and summarizes the best-practice guidelines about POD prevention and treatment which have been published within the last several years. We also describe our local experience with implementing a perioperative delirium risk stratification and prevention pathway, and review implementation science principles which others may find useful as they move toward risk stratification and prevention in their own institutions. RECENT FINDINGS: There are few areas of consensus, backed by strong experimental data, in POD best-practice guidelines. Most guidelines recommend preoperative cognitive screening, nonpharmacologic delirium prevention measures, and avoidance of deliriogenic medications. The field of implementation science offers strategies for closing the evidence-practice gap, which we supplement with lessons learned from our own experience implementing a perioperative delirium risk stratification and prevention pathway. SUMMARY: POD continues to be a serious perioperative complication commonly experienced by older adults. Growing appreciation of its prognostic implications and evidence behind multidisciplinary, collaborative, and focused prevention strategies rooted in implementation science have prompted several major groups to issue consensus guidelines. Adopting best practices POD risk stratification and prevention pathways will improve perioperative care for older adults.

Long-lived immunity to canine core vaccine antigens in UK dogs as assessed by an in-practice test kit.

OBJECTIVES: To determine the utility of an in-practice test kit to detect protective serum antibody against canine distemper virus, canine adenovirus and canine parvovirus type 2 in a sample of the UK dog population. MATERIALS AND METHODS: Serum samples from 486 dogs, last vaccinated between less than 1 month and 124 months previously, were tested with the VacciCheck™ test kit for protective antibodies against distemper, adenovirus and parvovirus type 2. RESULTS: A high proportion of the dogs tested (93·6%) had protective antibody against all three of the core vaccine antigens: 95·7% of the dogs were seropositive against canine distemper virus, 97·3% against canine adenovirus and 98·5% against canine parvovirus type 2. The small number of dogs that were seronegative for one or more of the antigens (n = 31) may have had waning of previous serum antibody or may have been rare genetic non-responders to that specific antigen. CLINICAL SIGNIFICANCE: UK veterinarians can be reassured that triennial revaccination of adult dogs with core vaccines provides long-lived protective immunity. In-practice serological test kits are a valuable tool for informing decision-making about canine core revaccination.

Effect of Caloric Restriction on Metabolic Dysfunction of Young Rapacz Familial Hypercholesterolemic Swine (Sus scrofa).

The Rapacz familial hypercholesterolemic (FH) swine model is well-characterized and used for studies of both spontaneous and inducible atherosclerosis but has not been used for studies of metabolic dysfunction to date. We examined whether parameters of metabolic syndrome including weight and adiposity, serum cholesterol, and glucoregulatory function could be modulated by restriction of caloric intake in the FH swine. Three groups of FH swine (n = 6 per group) were fed without restriction (AL), 80% of AL caloric intake, or 60% of AL caloric intake for 8.8 ± 0.5 mo beginning 2 wk after weaning. Caloric intake influenced the rate and magnitude of body weight gain and change in adiposity, as determined by dual-emission X-ray absorptiometry. At the conclusion of the study, pigs in the AL group reached a total least-square mean body weight of 94.2 kg and fat mass of 31.1%, whereas those fed 80% AL were 71.6 kg and 24.3% fat, and swine fed 60% AL were 46.1 kg and 14.1% fat. Serum cholesterol was greater in AL than 60% AL pigs at the end of the study. At 10 mo of age, intravenous glucose tolerance testing, performed to assess glucoregulatory function, indicated significant differences in serum glucose clearance profiles and insulin sensitivity between the AL- and 60% AL-fed swine. The AL-fed animals showed almost 5-fold lower insulin sensitivity when compared with animals fed 60% AL caloric intake. These results highlight the value of the FH swine model to study metabolic dysfunction due to changes in caloric intake.

Applying community health principles to veterinary practice.

Primary healthcare is the preferred approach to addressing human health problems and reducing the costs of healthcare in communities. ERWIN HOHN: and ADI NELL: believe that these principles should also be applied to animal healthcare systems.

Effects of a sexy appearance on perceived competence of women.

The present study replicates P. Glick, S. Larsen, C. Johnson, and H. Branstiter's (2005) previous research showing that a sexy appearance may be detrimental to women in high-status jobs. The authors used a larger sample and different stimulus materials and evaluation measures. As in the original experiment, participants rated sexually and professionally dressed women in both low- and high-status positions on perceived ability. The results were consistent with the original study and showed that high-status, sexually dressed women receive lower ratings in competence.

Field trial for assessment of avian influenza vaccination effectiveness in Indonesia.

The aim of this field study was to determine the efficacy of vaccination against highly pathogenic avian influenza (HPAI) virus strain H5N1 in Indonesia. A limited, prototype clinical trial was performed using a standardised treatment group, in which poultry flocks were vaccinated at least twice with a selected H5N1 vaccine, and a control group comprising flocks treated with non-standardised procedures chosen by the farmer. Each group consisted of six flocks comprising either layers or native chickens. Haemagglutination inhibition (HI) antibody levels were determined by regular serum sampling, and outbreak surveillance relied on non-AI-vaccinated sentinel birds. After three vaccinations high antibody titres were produced in the treatment group, and the percentage of layers with an HI titre > 40 was approximately 90%. Although no conclusions can be drawn regarding reduction of virus transmission, this study demonstrated that 11 farms remained free from AI during the observation period, and that a surveillance programme based on differentiating infected from vaccinated animals (DIVA) can be implemented.

Root canal system in the mesiobuccal root of the maxillary first molar: an in vitro comparison study of computed tomography and histology.

OBJECTIVES: The purpose of this study was to investigate a new diagnostic approach to the examination of the canal configuration of the mesiobuccal root of the maxillary first molar. MATERIALS AND METHODS: High-resolution computed tomography (CT) was compared with histology in vitro. There were 152 teeth investigated and classified according to Weine and Vertucci. RESULTS: CT describes the exact canal configuration, verifying information identical to histology, and thus serving as the "gold standard" in vitro. With regard to canal position, 9 (5.92%) of the teeth examined were Vertucci type 1, 48 (31.58%) were Vertucci type 2, 91 (59.87%) were Vertucci type 4, 1 (0.66%) was Vertucci type 5, 1 (0.66%) was Vertucci type 6. Of the 152 teeth examined, 3 (1.97%) could not be classified using Weine, 2 (1.31%) could not be classified according to either Weine or Vertucci, and no Vertucci types 3, 7 or 8 were identified. CONCLUSIONS: CT offers complete information on the number and configuration of root canals. As the root canal configuration of the adult does not change rapidly, CT investigations can be used for multiple subsequent treatments.

Identification and distribution of a novel Malassezia species yeast on normal equine skin.

This study aimed to investigate the distribution of Malassezia species yeasts on the skin of healthy horses. Acetate tape samples were obtained from the lip, axilla, interbulbar region, groin and anus of 12 healthy horses. The samples were stained and examined microscopically and sites harbouring yeast-like organisms were identified. Contact plates were applied to the skin at these sites and cultured at 26 degrees C and 32 degrees C. No growth was obtained on horse blood, Sabouraud's dextrose or modified Dixon's agar. A pure growth of a Malassezia-type organism was obtained on Sabouraud's dextrose agar enriched with oleic acid when it was incubated at 30 degrees C. It was identified by 26S ribosomal DNA D1/D2 sequence analysis as a member of the genus Malassezia, and most closely related to Malassezia sympodialis. However, the level of sequence divergence indicated that it was a novel species.

[Influence of risk factor "hot foods over 37 degrees Celsius" on oral flora and the pathogenesis of gingivitis and periodontitis]. / Der Einfluss des Risikofaktors "Nahrung mit mehr als 37 degrees C" auf die Keimzahl der Mundhöhle und die Entstehung von entzündlichen Parodontopathien.

Austrian law prescribes that hot food and beverages must be served at a minimum temperature of 75 degrees C. Within a group of 50 volunteers, we studied hot food at a temperature higher than 37 degrees C as a risk factor for the pathogenesis of gingivitis and periodontitis. In the first part of the investigation the effects of heat on bacterial growth in the mouth were evaluated. Bacterial growth was significantly reduced after drinking hot tea (70 degrees C) (p < 0.001). The ability of the volunteers to estimate the temperature of a direct heat stimulus in the mouth was tested in the second part of the study. 82% of the volunteers underestimated the temperature of tea (70 degrees C) by about 15 degrees C. In the third part of the study the periodontal state of the volunteers was determined by index measurements. Moreover, eating behaviour was assessed by a questionnaire. No statistically significant correlation between eating behaviour (hot/cold) and periodontal inflammation was found.

Evidence that cyclosporine inhibits periodontal prostaglandin I2 synthesis.

Cyclosporine (CsA) is a selective immunosuppressant widely used in clinical therapy. Like phenytoin and nifedipine, the drug is associated with gingival overgrowth. This study considers the interaction of CsA and prostaglandin I2 (PGI2), in particular the action of the drug on gingival tissue in vitro and in vivo. The PGI2-synthesis of rat, rabbit and human gingival tissue was examined by bioassay. In vivo CsA-therapy reduces gingival PGI2-synthesis. The results furthermore show a dose-dependent inhibition of PGI2-synthesis by CsA (1-100 micrograms/ml) in vitro. PGI2-synthesis from in vivo CsA-pretreated probes was further dose-dependently diminished by in vitro addition of CsA. As PGI2 exerts an antiproliferative activity via cAMP-elevation, the drug-induced inhibition of PGI2 production is claimed to be responsible for gingival hyperplasia in CsA-treated patients.

Influence of sE-selectin and L-selectin on the regulation of cell migration during chronic periodontitis.

Soluble endothelial leukocyte adhesion molecule-1 (sE-selectin) levels in peripheral blood (PB) and gingival capillary blood (GCB) of both healthy donors (HD) and patients with adult periodontitis (AP) were assayed by ELISA. Binding of sE-selectin to polymorphonuclear neutrophils (PMN) from PB, GCB and crevicular fluid (GF), and expression of L-selectin and sialyl-Lewisx (sLex) on these cells were analyzed by immunofluorescence and flow cytometry. No significantly enhanced serum levels of sE-selectin in patients with AP, compared to HD (28 +/- 5 ng/ml vs 19 +/- 3 ng/ml, respectively), and no differences in the concentration of sE-selectin in GCB (16 +/- 1 ng/ml vs 16 +/- 2 ng/ml, respectively) were observed. On PB-PMN no significant differences in the expression of L-selectin and sLex were found and binding of sE-selectin to PB-PMN was comparable between HD and patients with AP. Binding of sE-selectin to GCB-PMN was significantly higher in patients with AP compared to HD (mean channel fluorescence (MCF) = 88.5 +/- 13.2 vs MCF = 24.2 +/- 5.3, respectively). The expression of sLex on GCB-PMN did not differ significantly between the two groups. A significant decrease in the expression of the adhesion molecule L-selectin on GCB-PMNs compared to PB-PMN was found in patients with AP but not in HD. CF-PMN showed decreased expression of both L-selectin and sLex compared to PMN from PB and GCB, both in HD and patients with AP. Taken together, these data suggest that PMN from patients with AP had reduced selectin-mediated adhesive capabilities to inflamed gingival endothelium.

[Stimulation of platelet mitogen-induced prostaglandin I2 synthesis in periodontal tissue of cyclosporin A treated patients]. / Stimulation der Plättchenmitogen-induzierten Prostaglandin I2-Synthese in periodontalem Gewebe von Cyclosporin A-behandelten Patienten.

Cyclosporine A (CsA) is a highly potent immunosuppressive agent that has proven to be particularly useful in organ transplantation. Like phenytoin and the calcium antagonists, this drug may be associated with gingival hyperplasia. This study examined the interaction of platelet derived growth factor (PDGF) with prostaglandin I2 (PGI2)--a potent mediator in inflammation and bone resorption. PGI2 synthesis was examined by bioassay in gingival tissue from rats, rabbits and humans. Gingival tissue from CsA-treated patients generates less PGI2. PDGF causes a dose-dependent increase in PGI2 release in both CsA-treated and control subjects. The actual and percentage increase in PGI2 synthesis, however, was significantly higher in control tissue. While PDGF on the other hand modulated cellular proliferation, it causes on the other hand liberation of PGI2 from gingival tissue, thus interfering with its own action and further synthesis. If the PGI2 response is insufficient as after CsA therapy, the proliferative action might dominate. These findings therefore suggest an important pathogenetic role of PDGF and possibly other growth factors in CsA-induced gingival hyperplasia. "CsA gingivitis" seems to be a predominantly proliferative process, whereby inflammatory reactions appear only as a secondary phenomenon.

[Analysis of the fluoride content of drinking water in Austria 1993]. / Fluoridgehaltuntersuchung des Trinkwassers in Osterreich 1993.

This study was undertaken to determine the concentration of fluoride ions in drinking water in Austria. The results show that the fluoride ion concentration is sufficient (0.7-1.0 ppm F-) to prevent caries only in very few parts of Lower Austria, Upper Austria, Salzburg, Tirol, Carinthia, and Styria. Hence, additional fluoridation is necessary to achieve successful prophylaxis of caries.

Lectin binding to chronic inflammatory gingival tissue: possible adhesion mechanisms based on lectin-carbohydrate interactions.

In this study, we analyzed the expression of different leukocyte surface antigens, of the adhesion molecules ELAM-1 and GMP-140 and binding of various lectins and neoglycoproteins in inflamed gingival tissue. Cell suspensions from collagenase-digested gingiva were analyzed by flow cytometry in a FACScan. The expression of ELAM-1, GMP-140, carbohydrate structures and lectins in gingival specimens was also studied by immunohistochemistry. Gingival tissue of patients with active periodontal disease contained between 5% and 50% CD45+ mononuclear cells, consisting mainly of CD19+ cells (B lymphocytes). CD62, resembling GMP-140, and ELAM-1 were strongly expressed on endothelial cells of these patients. Control subjects usually contained almost no CD45+ cells in their gingiva and no CD62+ or ELAM-1-positive endothelial cells could be found in 5 of 6 control persons. Analysis of the glycosylation pattern revealed staining of infiltrating cells by peanut agglutinin (PNA; specificity for galactose), whereas soy bean agglutinin (SBA; specificity for N-acetyl-galactosamine) bound to epithelial cells. An endogenous lactosyl-specific lectin could be detected on endothelial cells by binding of lactosyl-BSA. Ulex europeus I agglutinin (UEA-1, specific for fucose) showed selective staining of endothelial and epithelial cells. Expression of a fucose-binding lectin, demonstrated by binding of fucosylated BSA, could be found on infiltrating cells. The adhesion molecules ELAM-1 and GMP-140 seem to be involved in cell adhesion during chronic inflammation of the gingiva. Interaction of other carbohydrate residues with endogenous lectins might resemble additional adhesion mechanisms in inflamed gingiva.

[Measuring drinking water fluoridation in Vorarlberg]. / Messung des Trinkwasserfluoridgehaltes in Vorarlberg.

A pilot study was undertaken in Vorarlberg to determine the concentration of fluoride ions in drinking water. The results showed that 91.3% of the population was supplied by drinking water containing under 0.3 ppm fluoride and the remaining 8.7% by drinking water containing 0.3-0.6 ppm fluoride. Hence, the fluoride concentration was too low to prevent caries in all areas of Vorarlberg. Exogenous fluoridation of the drinking water or table salt in all districts of Vorarlberg is discussed. Measurements are planned for the whole of Austria, which may lead to a general recommendation for fluoridation of the water or salt nationwide.

Constituents of wing gland and abdominal hair pencil secretions of male African sugarcane borer,Eldana saccharina walker (Lepidoptera: Pyralidae).

In addition totrans-3,7-dimethyl-6-octen-4-olide (eldanolide), vanillin, and 4-hydroxybenzaldehyde, identified by French workers in the wing gland and abdominal hair pencil secretions of the male African sugarcane borer,Eldana saccharina, we have, in an earlier note, reported the presence of several other terpenoid, aromatic, and unbranched-chain compounds such as, (Z)-3,7-dimethylocta-2,6-dienoic acid, 6,10,14-trimethyl-2-pentadecanol, 4-hydroxy-3-methoxybenzyl alcohol, 1-octadecane thiol, 16-hexadecanolide, and 18-octadecanolide in these secretions. In the present paper experimental details and spectral evidence supporting the identification of these compounds, as well as the identification of (Z)-9-hexadecenal and cw-3,7-di-methyl-6-octen-4-olide (cis-eldanolide), are reported. Using electroantennography it was found that male and female antennae reacted approximately equally strongly to both secretions. This result was confirmed in analyses of the secretions using coupled gas chromatography-electroantennography and it was found that male as well as female antennae responded to eldanolide. Vanillin, substituted phenols related to vanillin, and some oxygenated monoterpenes elicited weak responses in male and female antennae. In some analyses 6,10,14-trimethyl-2-pentadecanol, present in the secretions of the insect, gave a strong antennal response. The results obtained in dynamic and static headspace determinations showed that several of the organic compounds present in the glandular secretions are released in detectable quantities and are present in widely varying quantitative ratios in the effluvia of individual calling male moths.

Local benefit of prostaglandin E2 in radiochemotherapy-induced oral mucositis.

In 15 patients suffering from maxillofacial cancer with radiochemotherapy-induced oral mucositis the local application of prostaglandin E2 (PGE2) tablets, 0.5 mg four times a day at a 4-h interval was performed. Plasma determination of the bicyclo-prostaglandin E2 metabolite showed no significant amount of the locally applied substance in the circulation. It is claimed that for this particular indication, PGE2 is a potent locally acting compound without affecting circulating levels.