[The importance of a veterinary anaesthetist and pain treatment according to dog and cat owners]. / Bedeutung einer Veterinäranästhesistin oder eines Veterinäranästhesisten und einer optimalen Schmerztherapie aus Sicht von Hunde- und Katzenbesitzerinnen und -besitzer.

INTRODUCTION: In Switzerland, compared to the United Kingdom or the United States of America, fewer veterinary anaesthetists are employed in private practice, which raises the question about the reason. The present survey aimed at investigating the awareness of pet owners concerning the specialization of veterinary anaesthesia and the value they attribute to such a specialist. Also, estimation of pain in dogs and cats and the importance of its treatment from the point of view of the pet owners was analysed. Furthermore, the necessity of veterinary anaesthetists in private practice and the influencing factors were investigated. The survey was created on LimeSurvey, an online tool for questionnaires and sent to dog and cat owners of the small animal clinic of the University Hospital of Zurich. 317 fully completed questionnaires were evaluated. In general, pet owners appreciated the specialization of veterinary anaesthesiology. Great importance was attributed to the supervision of anaesthesia and analgesic therapy by a specialist. A preliminary talk with an anaesthetist would be appreciated. Owners would be willing to cover additional costs for a specialized anaesthetist, if recommended by the private veterinarian, and to bring their animal to the University Hospital, in case of an increased anaesthetic risk.

INTRODUCTION: En Suisse, les vétérinaires anesthésistes sont moins nombreux à exercer en cabinet privé qu'au Royaume-Uni ou aux États-Unis. La question se pose dès lors de savoir pourquoi il en est ainsi. Une enquête a analysé les connaissances des propriétaires d'animaux de compagnie sur la spécialisation de l'anesthésiologie vétérinaire et l'importance qu'ils accordent à un spécialiste en la matière. L'importance de la thérapie analgésique chez les chiens ou les chats a également été évaluée. En outre, le besoin en vétérinaires anesthésistes en pratique privée et les facteurs qui l'influencent ont été examinés. L'enquête a utilisé l'outil de questionnaire Lime-Survey et a été envoyée aux propriétaires de chiens et de chats de la Clinique des petits animaux de l'Université de Zürich. 317 questionnaires complétés ont été évalués. Les propriétaires d'animaux apprécient la spécialisation en l'anesthésiologie vétérinaire. Le vétérinaire anesthésiste est considéré comme très important dans les mesures anes-thésiques et la thérapie analgésique. Une consultation anesthésique préalable est souhaitée. Les propriétaires seraient disposés à prendre en charge les coûts supplémentaires de ce service ou, sur recommandation du vétérinaire privé, à amener leur animal à la Clinique pour petits animaux de l'Université de Zürich en cas de risque anesthésique accru.

[Iron-deficiency anemia and gastrointestinal bleeding]. / Eisenmangelanamie bei gastrointestinalen Blutungen.

The physiology of iron homeostasis, clinical presentation, diagnosis, differential diagnosis and therapeutic options in iron-deficiency anemia are discussed. Iron deficiency is the most common haematological disorder encountered in general practice and iron-deficiency anemia is the most frequently occurring anemia throughout the world. Blood loss is a major cause of iron-deficiency anemia. Gastrointestinal bleeding is the most common cause of iron deficiency in adult men and is second only to menstrual blood loss as a cause in women. Iron-deficiency anemia is not a disease itself but a manifestation of an underlying disease, searching for the latter is therefore crucial and may be of far greater importance to the ultimate well-being of the patient than repleting iron stores. The symptoms and signs of iron deficiency are partially explained by the presence of anemia. However, there also appears to be a direct effect of iron deficiency on the central nervous system. The most important screening investigations for iron deficiency in clinical practice are the haemoglobin, the haematocrit and the mean corpuscular volume (MCV). The single most important measure of iron status is the serum ferritin, values below the lower limit of normal being specific for iron deficiency. In inflammation, hepatopathy and haemolysis serum ferritin is also released leading to falsely elevated values, therefore an analysis of the C-reactive protein (CRP) should always accompany the analysis of serum ferritin. Repleting iron stores is usually done with oral iron therapy, the available preparations are comparable with respect to efficacy, side effects and costs. The main indications for parenteral iron therapy are intolerance to oral iron, intestinal malabsorption and poor compliance to an oral regimen. The iron sucrose preparation should bepreferentially used for that purpose, the total dose is calculated from the amount of iron needed to restore the haemoglobin deficit plus an additional amount to replenish iron stores.

Fatigue in MS is related to sympathetic vasomotor dysfunction.

The authors studied standard autonomic function tests and measures of heart rate variability in 60 patients with multiple sclerosis (MS) and correlated results with the Fatigue Severity Scale and the Modified Fatigue Impact Scale. The authors found that autonomic responses correlated with fatigue resembling a hypoadrenergic orthostatic response, possibly due to a sympathetic vasomotor lesion with intact vagal heart control. Treatments to control sympathetic dysfunction for MS-associated fatigue deserve further study.

[Anticoagulation in patients with venous thromboembolism]. / Antikoagulation bei Patienten mit venöser Thromboembolie.

Deep venous thrombosis and pulmonary embolism are considered to be two variants of one disease--'venous thromboembolism'. Pathogenesis, therapy and prognosis of these both entities are very similar and therefore the term 'venous thromboembolism' has been used in recent literature. The cornerstone of therapy is anticoagulation and initially consists of heparin for at least five days. Because of pharmacokinetic advantages low molecular weight heparins are the therapy of choice. They are as efficient and save as unfractionated heparins and allow weight-adapted dosing with daily subcutaneous injections in most patients. Low molecular weight heparins do not require regularly laboratory monitoring with few exceptions, e.g. renal failure. Therefore outpatient treatment of deep venous thrombosis is possible in most patients. Although there are promising data about outpatient treatment of pulmonary embolism, this is still being studied and can not be recommended outside clinical trials. Introduction of coumarin therapy for venous thromboembolism should be started on day 1 of diagnosis, keeping the total duration of heparin therapy at no more than five days and therefore minimizing the incidence of heparin-induced thrombocytopenia. Evidence from multiple studies indicates that effective coumarin therapy in venous thromboembolism is usually reflected by an INR of 2.0 to 3.0. In patients with massive and hemodynamically relevant thromboembolism alternative therapeutic approaches such as thrombolytic therapy, thrombectomy or insertion of intravenous filters may be useful. Adequately fit compression stockings can reduce the risk of post-thrombotic syndrome after deep venous thrombosis.

Dimerization-induced activation of soluble insulin/IGF-1 receptor kinases: an alternative mechanism of activation.

To study the role of kinase dimerization in the activation of the insulin receptor (IR) and the insulin-like growth factor receptor-1 (IGF-1R), we have cloned, expressed, and purified monomeric and dimeric forms of the corresponding soluble kinase domains via the baculovirus expression system. Dimerization of the kinases was achieved by fusion of the kinase domains to the homodimeric glutathione S-transferase (GST). Kinetic analyses revealed that kinase dimerization results in substantial increases (10-100-fold) in the phosphotransferase activity in both the auto- and substrate phosphorylation reactions. Furthermore, kinase dimerization rendered the autophosphorylation reaction concentration-independent. However, whereas dimerization was required for the rapid autophosphorylation of the kinases, it was not essential for the enhanced kinase activity in substrate phosphorylation reactions. Comparison of HPLC-phosphopeptide maps of the monomeric and dimeric kinases revealed that dimerization leads to an increased phosphorylation of the regulatory activation loop of the kinases, strongly suggesting that bis- and trisphosphorylation of the activation loop are mediated by transphosphorylation within the kinase dimers. Most strikingly, limited proteolysis revealed that GST-mediated dimerization by itself had a major impact on the conformation of the activation loop by stabilizing a conformation that corresponds to the active, phosphorylated form of the kinase. Thus, in analogy to the insulin/IGF-1-ligated holoreceptors, the dimeric GST-kinases are primed to rapid autophosphorylation by an increase in the local concentration of both phosphoryl donor and phosphoryl acceptor sites and by a dimerization-induced conformational change of the activation loop that leads to an efficient transphosphorylation of the regulatory tyrosine residues.

The presentation, treatment and outcome of renal cell carcinoma in old age.

OBJECTIVE: To review clinical presentation and outcome of patients with a diagnosis of renal cell carcinoma at a district general hospital and assess whether older patients were more likely to present in a non-specific manner or receive more conservative management and whether their survival was less favourable. SUBJECTS AND METHODS: 39 patients presenting with a diagnosis of renal cell carcinoma between 1987 and 1995 were identified from hospital activity analysis data and histopathology records. We divided the subjects into young patients (< 69 years: n = 27) and elderly patients (>70 years: n = 10), and made a retrospective analysis of clinical features, laboratory results, pathology, staging, treatment and survival from hospital records. RESULTS: Anaemia, hypertension and weight loss were common clinical features in both young and elderly groups. The prevalence of non-urological symptoms did not differ between study groups. Anaemia was frequently microcytic and hypochromic. Hypertension was present in 46% of patients and one-third of these were newly diagnosed. In 19% of patients with renal cell carcinoma, the diagnosis was made incidentally while imaging for other indications. Elderly patients were as likely to receive surgical treatment as younger patients. Survival differed with stage but not age. CONCLUSIONS: Neither clinical presentation, management nor survival differed between the young and elderly subjects. Renal cell carcinoma should be considered in elderly patients with systemic features such as malaise or weight loss associated with anaemia, hypertension and raised erythrocyte sedimentation rate.