Idiopathic seasonal alopecia in horse: case report / Alopecia sazonal idiopática em equino: relato de caso

This report describes the first case of idiopathic seasonal alopecia in a horse in Brazil. The disease is of unknown etiology, characterized by alopecic processes in the thoracic and lateral abdominal regions, in a bilaterally symmetrical way. An eight-year-old male grade horse was treated presenting hair loss in a bilaterally symmetrical manner in the arm and abdomen areas, without any other associated clinical signs. The areas with alopecia showed no pruritus, inflammation or scaling. On the epidermis, the histological evaluation presented irregular hyperplasia, hyperpigmentation, compact orthokeratosis, edema and an inflammatory infiltrate. The hair follicles were active and containing hair shaft. The case was monitored with photographic records for two consecutive years (2012 to 2014), in which the hair fall occurred at the end of autumn with spontaneous hair growth in the middle of the summer. The diagnosis was based on the history, histopathology and photographic follow-up performed. Although mentioned in the literature, this is the first clinical and pathological description of such disorder affecting an equine in Brazil.(AU)

Relata-se o primeiro caso de alopecia sazonal idiopática em um equino no Brasil, doença de etiologia desconhecida, caracterizada por processos alopécicos, nas regiões torácicas e abdominais laterais, de forma simétrica bilateralmente. Um equino mestiço, macho, de oito anos de idade, foi atendido sob queixa de perda dos pelos em regiões do tórax e do abdômen, simétrica bilateralmente, sem qualquer outro sinal clínico associado. As regiões alopécicas não apresentavam prurido, inflamação nem descamação. A avaliação histológica revelou, na epiderme, hiperplasia irregular, hiperpigmentação e ortoqueratose compacta, edema e infiltrado inflamatório. Os folículos pilosos estavam ativos e contendo hastes de pelos. O caso foi acompanhado com registros fotográficos durante dois anos consecutivos (2012 a 2014), com a queda do pelo acontecendo no final do outono e com retorno espontâneo em meados do verão. O diagnóstico baseou-se no histórico, na histopatologia e no acompanhamento fotográfico. Mesmo sendo mencionada na literatura, esta é a primeira descrição clínico-patológica de tal distúrbio acometendo um equino no Brasil.(AU)

Stephanofilariasis in beef cattle - case report / Estefanofilariose em bovinos de corte - relato de caso

Stephanofilariasis is an ulcerative dermatitis caused by nematodes that affect cattle in several countries in the world. However, it has not been described in beef cattle in Brazil. The objective of this study is to describe three cases of stephanofilariasis, which occurred in beef cows in the municipality of Ipê, RS, Brazil. The disease was characterized by pruritic, ulcerated and crusty seasonal lesions present in the cranial region of the udder. The diagnosis was confirmed by analyses of secretions stained smears and by direct optical microscopic examination of the sediment and the treatment was effectively carried out with topical trichlorphon. This report indicates that stephanofilariasis should be included as a differential diagnosis for dermatopathies in beef cattle in Brazil.(AU)

A estefanofilariose é uma dermatite ulcerativa causada por nematódeos que acometem bovinos em vários países do mundo, no entanto não tem sido descrita em bovinos de corte no Brasil. O objetivo do trabalho é a descrição de três casos de estefanofilariose em vacas de corte ocorridos no município de Ipê, RS. A enfermidade foi caracterizada por lesões sazonais pruriginosas, ulceradas e crostosas, presentes na região cranial do úbere. O diagnóstico foi confirmado pela análise dos esfregaços corados das secreções e por exame direto do sedimento em microscopia óptica, e o tratamento foi realizado de maneira eficaz com triclorfon tópico. Este relato demonstra que a estefanofilariose deve ser incluída como diagnóstico diferencial nas dermatopatias em bovinos de corte no Brasil.(AU)

Serum proteinogram of the Campeiro horse / Proteinograma sérico de equinos da raça Campeiro

The aim of this study to measure the fractions of the total serum proteins of the Campeiro horse and identify the influences of biological variants. Blood samples were taken in 138 horses of the breed Campeiro for measuring the concentration of total serum protein by the biuret method. Serum concentrations of protein fractions were measured by electrophoresis using agarose gel. Groups were formed according to age, sex and reproductive condition. The average values of serum fractions: albumin (2.85±0.36g/dl), alpha 1 (0.28±0.11g/dl), alpha 2 (0.26±0.08g/dL) beta 1 (0.57±0.15g/dl), beta 2 (0.89±0.28g/dL), gamaglobulinas (1.86±0.34g/dL), albumin/globulin ratio (0.75±0.18) and 2.5% percentile and 97.5% had slight differences in relation to the reference interval proposed for the species. They observed higher values of alpha 1 and 2 globulins in the group from that had six to eight years old and gammaglobulins in group above 13 years old. Serum protein concentrations were similar in horses and mares and between non-pregnant and pregnant. Sex and pregnancy status did not affect serum proteinogram. Alpha and gammaglobulins have higher values as the age increases. Serum proteinogram of Campeiro horses shows variations that have to be considered in the interpretation of laboratory tests.(AU)

Este trabalho tem por objetivo mensurar as frações das proteínas totais séricas de equinos Campeiros e identificar as influências de variantes biológicas. Foram colhidas amostras de sangue de 138 equinos, machos e fêmeas da raça Campeiro. A determinação da concentração de proteínas totais séricas foi realizada pelo método de biureto. As concentrações séricas das frações proteicas foram determinadas por eletroforese, utilizando-se gel de agarose. Formaram-se grupos em relação à idade, ao sexo e à condição reprodutiva. Os valores médios das frações séricas albumina (2,85±0,36g/dL), alfa 1 (0,28±0,11g/dL), alfa 2 (0,26±0,08g/dL), beta 1 (0,57±0,15g/dL), beta 2 (0,89±0,28g/dL), gamaglobulinas (1,86±0,34g/dL), relação albumina/globulina (0,75±0,18) e os percentis 2,5% e 97,5% apresentaram diferenças pontuais em relação aos intervalos propostos para a espécie. Observaram-se maiores valores de alfa 1, alfa 2 globulinas, no grupo de seis a oito anos, e de gamaglobulinas, no grupo acima de 13 anos de idade. O proteinograma sérico foi similar entre machos e fêmeas e entre fêmeas vazias e gestantes. Sexo e estado gestacional não afetaram o proteinograma sérico. Alfa e gamaglobulinas têm incrementos em função de idades crescentes. O proteinograma sérico de equinos Campeiros tem variações que devem ser consideradas em exames laboratoriais.(AU)

Chronic renal failure in equine due to ascending pyelonephritis predisposed by cauda equina syndrome: case report / Insuficiência renal crônica em equino devido à pielonefrite ascendente predisposta por síndrome da cauda equina: relato de caso

Descreve-se o caso de uma égua, da raça Campeiro, utilizada como doadora de embriões, que apresentava quadros de cistite recorrente e incontinência urinária. Os sinais clínicos evoluíram para emagrecimento progressivo, anorexia, apatia e isolamento do plantel. Ao exame físico, foi identificada hipotonia da cauda, hipoalgesia da região perineal, flacidez retal e vesical, compatíveis com sinais relacionados à síndrome da cauda equina. Exames complementares laboratoriais, exame ultrassonográfico e necropsia confirmaram o diagnóstico de insuficiência renal crônica (IRC), a qual foi atribuida à pielonefrite ascendente. O exame de urocultura demonstrou crescimento de bactérias do gêneroStreptococcus sp. Este é um caso raro em equinos em que a disfunção de neurônio motor inferior propiciou o desenvolvimento de processo infeccioso no trato urinário, progredindo para um quadro crônico renal incompatível com a vida.(AU)

Descreve-se o caso de uma égua, da raça Campeiro, utilizada como doadora de embriões, que apresentava quadros de cistite recorrente e incontinência urinária. Os sinais clínicos evoluíram para emagrecimento progressivo, anorexia, apatia e isolamento do plantel. Ao exame físico, foi identificada hipotonia da cauda, hipoalgesia da região perineal, flacidez retal e vesical, compatíveis com sinais relacionados à síndrome da cauda equina. Exames complementares laboratoriais, exame ultrassonográfico e necropsia confirmaram o diagnóstico de insuficiência renal crônica (IRC), a qual foi atribuida à pielonefrite ascendente. O exame de urocultura demonstrou crescimento de bactérias do gênero Streptococcus sp. Este é um caso raro em equinos em que a disfunção de neurônio motor inferior propiciou o desenvolvimento de processo infeccioso no trato urinário, progredindo para um quadro crônico renal incompatível com a vida.(AU)

Systemic toxic reaction due to multiple honeybee stings in equine: Case report / Reação tóxica sistêmica devido a múltiplas ferroadas de abelha em equino: relato de caso

Accidents caused by insects of the Hymenoptera are rarely described in large animals. The attacks caused by honeybee (Apis mellifera) may cause severe consequences and its intensity changes according to the number of stings. Local and systemic reactions can occur, including progression to death. This report describes a case of honeybee attack on an equine, which took place in the city of Lages, in the state of Santa Catarina, Brazil. In the clinical assessment the horse showed apathy, anorexia, head and pectoral edemas, dyspnea, icteric mucosa, increased mandibular lymph nodes and darkened urine. The blood count showed anemia and serum biochemical tests suggested, muscular and hepatic lesions. The urinalysis test indicated hemoglobinuria and increased clotting time. Treatment included lactate Ringer's solution fluid therapy, furosemide, promethazine, corticosteroids and 20% mannitol solution. Hot and cold compresses were applied alternately on areas with edema. There was a satisfactory response to treatment and the animal was discharged after 30 days in veterinary hospital. The description of honeybee sting accidents in large animals is important because of the evolution that can lead to death. The early approach associated with appropriate treatment, avoiding the worsening of the lesions is fundamental for the recovery of the patient.(AU)

Os acidentes causados por insetos da ordem Hymenoptera são raramente descritos em grandes animais. Os ataques provocados por abelhas (Apis mellifera) causam consequências graves, e sua intensidade varia de acordo com a quantidade de ferroadas. Reações locais a sistêmicas podem ocorrer, incluindo a evolução para a morte. Este relato descreve um caso de ataque por abelhas em equino, ocorrido no município de Lages, SC. No exame clínico, o equino apresentava apatia, anorexia, edema de cabeça e região peitoral, dispneia inspiratória, mucosas ictéricas, linfonodos mandibulares aumentados e urina de coloração marrom-escura. O hemograma evidenciou anemia hemolítica, e os exames de bioquímica sérica sugeriram lesão muscular e lesão hepática. A urinálise demonstrou hemoglobinúria, e o tempo de coagulação apresentava-se aumentado. Como tratamento, foram administrados solução de ringer com lactato, furosemida, prometazina, corticosteroides e solução de manitol a 20%. Compressas quentes e frias foram aplicadas alternadamente sobre as áreas de edema. Houve adequada resposta ao tratamento instituído e o animal recebeu alta hospitalar após 30 dias de internamento. A descrição de casos de acidentes por picadas de abelhas em grandes animais é importante devido à evolução, que pode levar à morte. A abordagem precoce associada ao tratamento adequado, evitando o agravamento das lesões, é fundamental para a recuperação do paciente.(AU)

Estudo anatômico, ultrassonográfico e tomográfico do aparato podotroclear de equinos adultos / Anatomic, tomographic and sonographic study of podotrochlear apparatus of adult horses

A síndrome do navicular é uma condição que envolve o aparato podotroclear e representa uma das causas mais comuns de claudicação dos membros torácicos de equinos. Portanto, o estudo complementar da região reveste-se de grande interesse quando se refere ao diagnóstico e tratamento das claudicações dos equinos. O objetivo deste estudo foi demonstrar as diferenças dos achados imagenológicos entre a ultrassonografia e a tomografia computadorizada na avaliação das estruturas palmares do aparato podotroclear de equinos adultos e hígidos, bem como a descrição das estruturas observadas nas imagens obtidas com essas técnicas. Para isso, foram realizadas imagens de quatro peças anatômicas, as quais foram posteriormente seccionadas e utilizadas para a descrição anatômica. A utilização de peças anatômicas auxilia no conhecimento da anatomia normal, o que leva à melhor interpretação das imagens e aumenta a especificidade diagnóstica na detecção das alterações que as doenças acarretam. A ultrassonografia fornece informações relevantes quanto às estruturas estudadas, e sua associação com a tomografia computadorizada aumentou a acurácia da investigação. Apesar de o uso da tomografia computadorizada ser mais indicada para tecido ósseo, ela fornece informações importantes, podendo ser usada como uma ferramenta útil quando não se tem disponível a ressonância magnética em razão do custo ou da disponibilidade.(AU)

The navicular syndrome is a condition involving the podotrochlear apparatus and represents one of the most common causes of forelimb lameness in horses. Therefore, further study of this region is of interest when it comes to diagnosis and treatment of lameness in horses. The aim of this study was to demonstrate the differences between the imaging findings of ultrasonography and computed tomography in the evaluation of the palmar structures of the podotrochlear apparatus of healthy adult horses and description of the structures observed in images obtained with these techniques. For this, four images of four anatomical parts were performed, and subsequently sectioned and used for the anatomical description. The use of anatomical parts helps in the understanding of normal anatomy leading to a better interpretation of the images and increasing the specificity of the diagnostic for detecting changes that cause diseases. Ultrasonography provides relevant information about these structures to be studied and the association with computed tomography (CT) increased the accuracy of the investigation. Despite the use of CT being more suitable for bone tissue it provides important information and can be used as a useful tool when there is no available MRI.(AU)

Perfil bioquímico sérico de equinos clinicamente sadios da raça Campeiro / Serum biochemical profile from clinically healthy Campeiro horses

Amostras de sangue foram obtidas de 138 equinos registrados da raça Campeiro, com idade média de 9,7±5,4 anos, sendo 14 machos (10,15%) e 124 fêmeas (89,85%). Observaram-se valores médios da atividade sérica de GGT: 13,73±4,08 U/L; AST: 246,34±72,87U/L; ALT: 5,13±1,18U/L; FA: 284,32±53,33UI/L; CK: 132,54±72,25U/L; LDH: 511,38±143,65U/L; e das concentrações séricas de ureia: 38,65±12,62mg/dL e de creatinina: 1,24±0,24mg/dL. Os valores médios de AST, FA, ALT, ureia e creatinina foram semelhantes aos propostos na literatura para outras raças. Os valores de CK, GGT e LDH foram superiores aos comumente utilizados como referências. Não houve diferença nas concentrações de nenhum dos componentes séricos avaliados nas diferentes idades analisadas. Maiores valores médios nas concentrações de ureia e menores de creatinina foram observados nas fêmeas em relação aos machos, assim como a maior atividade sérica de FA em fêmeas gestantes em relação às éguas vazias. O perfil bioquímico sérico de equinos sadios da raça Campeiro apresenta variações peculiares que devem ser levadas em consideração na interpretação de exames laboratoriais.(AU)

Blood samples were obtained from 138 equines of the Campeiro breed with mean ages of 9.7±5.4 years, including 14 males (10.15%) and 124 mares (89.85%). Mean values of serum of GGT: 13.73 ± 4.08U/L; AST: 246.34±72.87U/L; ALT 5.13±1.18U/L; FA: 284.32±53.33IU/L; CK: 132.54±72.25U/L; LDH: 511.38±143.65U/L; and serum urea: 38.65±12.62mg/dL and creatinine: 1.24±0.24mg/dL were observed. The mean values of AST, FA, ALT, urea and creatinine were similar to those proposed in the literature for other breeds. The CK values, GGT, and LDH were higher than those commonly used as references. There was no difference in the concentrations of any of the serum components evaluated at different ages analyzed. Further average values in the lower urea concentrations and creatinine were observed in females compared to males, as well as the higher serum activity of FA in pregnant mares in relation to non-pregnant. Serum biochemical profile of healthy horses of the Campeiro breed presents peculiar variations that must be taken into consideration in the interpretation of laboratory tests.(AU)

Avaliação morfométrica de equinos do esquadrão de polícia montada dos municípios de lages, joinville e florianópolis-sc / Morphometric evaluation of equine from squadron of mounted police in lages, joinville and florianopolis-sc

O objetivo do presente trabalho foi avaliar as características morfométricas de equinos utilizados no patrulhamento ostensivo pertencentes aos Esquadrões de Polícia Montada localizados nos municípios de Lages, Joinville e Florianópolis - SC. Foram utilizados 101 animais (78 machos castrados, um garanhão e 22 fêmeas), com idade média de 11,9 anos e massa corpórea de 490,82±53,51kg. Foram tomadas 20 medidas lineares individuais, por meio das quais foram determinados 13 índices zootécnicos. Os dados foram avaliados segundo análise descritiva, e a comparação simples entre médias pelo teste t de Student (P<0,05). Houve diferença significativa entre machos e fêmeas com relação ao comprimento de garupa, largura da anca, perímetro da canela e IDT nos animais pertencentes ao Esquadrão de Florianópolis. Conclui-se que os equinos dos três Esquadrões avaliados são, em geral, animais baixos de frente, "longe de terra", eumétricos e longilíneos, e classificados entre animais de tração ligeira e de tração pesada.

The aim of this study was to evaluate the morphometric characteristics of horses utilized in ostensive patrolling belonging to Squadrons of Mounted Police located in the cities of Lages, Joinville and Florianópolis - SC. One hundred and one animals were used (78 geldings, a stallion and 22 females) with a mean age of 11.9 years and body mass of 490.82±53.51kg. Twenty individual linear measurements were taken, from which 13 zootechnical indexes were determined. The data was evaluated according to descriptive analysis and simple comparison between averages by Student's t test (P<0.05). There were significant differences between males and females in relation to hip length, hip width, cannon bone circumference and dactyl-thoracic index (DTI) in animals belonging to the Squadron of Florianopolis. We conclude that equines from three evaluated Squadrons are generally low front animals, "far from the ground", middleweight and large in shape, classified between light traction and heavy traction animals.

Reduced airway inflammation in CD26/DPP4-deficient F344 rats is associated with altered recruitment patterns of regulatory T cells and expression of pulmonary surfactant proteins.

INTRODUCTION: CD26 is highly expressed on lung epithelial cells as well as on immune cells. Ovalbumin (OVA)-induced airway inflammation induces a further increase of CD26 expression. CD26-deficient rat strains exhibit blunted clinical courses in models of experimental asthma. OBJECTIVE: (1) To investigate the involvement of regulatory T cells (Tregs) and the surfactant system in a rat model of genetic CD26 deficiency. (2) To investigate regulatory mechanisms dependent on the endogenous CD26 expression. (3) To investigate the impact of CD26 on surfactant protein (SP)-levels under inflammatory conditions. METHODS: Wild-type and CD26-deficient F344 rats were sensitized to and challenged with OVA. Subsequently, airway inflammation, SP levels as well as surface tension of the bronchoalveolar lavage (BAL) fluid were evaluated. RESULTS: CD26 deficiency led to decreased airway inflammation, e.g. reduced numbers of eosinophils and activated T cells in the BAL. Remarkably, the CD26-deficient rats exhibited a significantly increased influx of FoxP3(+) Tregs into the lungs and increased IL-10-secretion/production by draining lymph node cells in culture experiments. Furthermore, in OVA-challenged CD26-deficient rats, the increase of the expression of the collectins SP-A and SP-D as well as of the surface tension-active SP-B was significantly less pronounced than in the CD26-positive strain. Only in the wild-type rats, functional alterations of the surfactant system, e.g. the increased surface tension were obvious after OVA challenge. CONCLUSION: Reduced airway inflammation in CD26-deficient F344 rats appear to be mediated by differences in the recruitment and activity of Tregs. This altered inflammation is associated with differences in the SP expression as well as function.

Airway-specific recruitment of T cells is reduced in a CD26-deficient F344 rat substrain.

Asthma is a chronic inflammatory disease affecting the airways. Increased levels of T cells are found in the lungs after the induction of an allergic-like inflammation in rats, and flow cytometry studies have shown that these levels are reduced in CD26-deficient rats. However, the precise anatomical sites where these newly recruited T cells appear primarily are unknown. Therefore, we quantified the distribution of T cells in lung parenchyma as well as in large, medium and small airways using immunohistochemical stainings combined with morphometric analyses. The number of T cells increased after the induction of an allergic-like inflammation. However, the differences between CD26-deficient and wild-type rats were not attributable to different cell numbers in the lung parenchyma, but the medium- and large-sized bronchi revealed significantly fewer T cells in CD26-deficient rats. These sites of T cell recruitment were screened further using immunohistochemistry and quantitative real-time polymerase chain reaction with regard to two hypotheses: (i) involvement of the nervous system or (ii) expression of chemokines with properties of a T cell attractor. No topographical association was found between nerves and T cells, but a differential transcription of chemokines was revealed in bronchi and parenchyma. Thus, the site-specific recruitment of T cells appears to be a process mediated by chemokines rather than nerve-T cell interactions. In conclusion, this is the first report showing a differential site-specific recruitment of T cells to the bronchi in a CD26-deficient rat substrain during an asthma-like inflammation.

CD26/dipeptidyl peptidase 4-deficiency alters thymic emigration patterns and leukcocyte subsets in F344-rats age-dependently.

As CD26 (dipeptidyl peptidase 4/DPP4) rapidly truncates incretins N-terminally, including glucagon-like peptide-1, DPP4-inhibitors have been developed for treatment of diabetes type 2. To some extent this is surprising, as CD26/DPP4 is also deeply involved in immune regulation. Long-term pharmacological studies are hampered by off-target inhibition of DPP4-homologues. Therefore, we studied the effects of genetic CD26/DPP4-deficiency by investigating blood, spleen and thymus leucocyte subpopulations of wild-type and CD26-deficient F344-rats at different ages. In young animals at 1 and 3 months of age, there were no differences in leucocyte subsets, while in older animals the T cell composition was changed significantly. From the age of 6 months onwards, reduced numbers of recent thymic emigrants and memory T cells, and consequently an increased amount of naive T cells were observed in CD26-deficient rats. In addition, the architecture of the thymus was altered, as observed by a reduced density of lymphocytes in the medulla. Furthermore, the number of proliferating cells in the thymus was decreased in CD26-deficient rats at a higher age. Moreover, CD26-deficiency resulted in markedly reduced numbers of B cells in later life. Additionally, an age- but not CD26-dependent increase of regulatory T cells and a decrease of natural killer cell numbers were detected in the blood and spleen. Our findings indicate an important role of CD26 in maintaining lymphocyte composition, memory T cell generation and thymic emigration patterns during immunosenescence, with possible implications for using DPP4-inhibitors.

Extensive natural intraspecific variation in stoichiometric (C:N:p) composition in two terrestrial insect species.

Heterotrophic organisms must obtain essential elements in sufficient quantities from their food. Because plants naturally exhibit extensive variation in their elemental content, it is important to quantify the within-species stoichiometric variation of consumers. If extensive stoichiometric variation exists, it may help explain consumer variation in life-history strategy and fitness. To date, however, research on stoichiometric variation has focused on interspecific differences and assumed minimal intraspecific differences. Here this assumption is tested. Natural variation is quantified in body stoichiometry of two terrestrial insects: the generalist field cricket, Gryllus texensis Cade and Otte (Orthoptera: Gryllidae) and a specialist curculionid weevil, Sabinia setosa (Le Conte) (Coleoptera: Curculionidae). Both species exhibited extensive intraspecific stoichiometric variation. Cricket body nitrogen content ranged from 8-12% and there was a four-fold difference in body phosphorus content, ranging from 0.32-1.27%. Body size explained half this stoichiometric variation, with larger individuals containing less nitrogen and phosphorus. Weevils exhibited an almost three-fold difference in body phosphorus content, ranging from 0.38-0.97%. Overall, the variation observed within each of these species is comparable to the variation previously observed across almost all terrestrial insect species.

A microfluorometric method for quantifying RNA and DNA in terrestrial insects.

Evidence is accumulating for a mechanistic linkage between body phosphorus content and growth and reproduction of individual organisms, due in part to variation in allocation of resources to ribosomal RNA. Testing this connection requires reliable methods of quantifying the nucleic acid content of individual organisms. Although methods for quantifying nucleic acids are available for a wide array of organisms, adaptation of such methods for study of insects has been neglected. Sensitive stains and high throughput fluorometric measurements are now available that substantially improve past methodologies. Here we present methods for the extraction and quantification of insect RNA and DNA based on the use of N-lauroylsarcosine and sonication for extraction, the nucleases RNase and DNase, and the use of microplate fluorescent assays to quantify nucleic acids as percent of body weight in insects. We illustrate the method using Drosophila and curculionid weevils.

Clinical and biochemical changes following 131I therapy for hyperthyroidism in patients not pretreated with antithyroid drugs.

BACKGROUND: Radioiodine therapy (131I) for the treatment of hyperthyroidism has been shown to be effective and safe. Despite the extensive experience with radioiodine therapy, the necessity for pretreatment with antithyroid drugs is controversial. Pretreatment is partly based on the concept that antithyroid drugs deplete the thyroidal hormonal stores, thereby reducing the risk of a radioiodine-induced aggravation of hyperthyroidism or thyroid storm. Few data are available on the frequency of clinically significant exacerbations of hyperthyroidism following 131I therapy without prior treatment with antithyroid drugs. The aim of the present study was to determine prospectively the early clinical and biochemical changes after 131I therapy in patients who were not pretreated with antithyroid drugs. METHODS: Patients with Graves' disease (n = 21), toxic multinodular goiter (n = 11) or toxic adenoma (n = 2) were studied before and after 131I therapy. Clinical and biochemical parameters of thyroid function were investigated before and 1, 2, 8, 11, 18 and 25 days after 131I treatment. Patients were given no antithyroid drugs prior to 131I therapy, all patients received beta-blocking agents for symptomatic relief. RESULTS: In 19 of 34 patients, a transient increase in thyroid hormone levels was observed, predominantly in the first week following 131I therapy. None of these patients experienced worsening of thyrotoxic symptoms. This transient increase in thyroid hormone levels was demonstrated in all patients with toxic multinodular goiter, whereas it was found in only six of 21 patients with Graves' disease. This difference could not readily be explained by differences in pretreatment thyroid hormone levels, administered dose or effectively absorbed dose of 131I. CONCLUSIONS: 131I treatment of hyperthyroidism without pretreatment with antithyroid drugs may cause a transient increase in thyroid hormone levels. Clinically significant exacerbations of hyperthyroidism were, however, not observed in our study population. Increased hormone levels following 131I therapy were more often seen in patients with toxic multinodular goiter than in patients with Graves' disease.

Comparison of three preverbal scales for postoperative pain assessment in a diverse pediatric sample.

The purposes of this study were to compare the reliability and validity of three pain measurement scales for assessing pain in preverbal and nonverbal children and to determine which of the scales was most appropriate in a clinical setting to evaluate pain for infants and young children regardless of developmental stage or cognitive or physical disability. Pain scales tested were revised versions of the Riley Infant Pain Scale (RIPS), the Nursing Assessment of Pain Intensity (NAPI), and the Postoperative Pain Score (POPS). Purposive sampling of 391 postoperative infants and children was used for evaluation of pain in a midwestern children's hospital. Four assessments with each scale were done 1 hr apart by trained observers blinded to pain medications. Data analyses supported high inter-rater reliability, satisfactory discrimination between pain and no-pain observations, and suggested acceptability for all three scales with lower caregiver burden for RIPS and NAPI.

Reliability and validity of the Faces and Word Descriptor Scales to measure procedural pain.

Reliability and validity of the Faces and Word Descriptor Scales to measure pain in verbal children undergoing painful procedures were assessed. Test-retest reliability and construct and discriminant validity were supported for both instruments among a sample of 118 children in three age groups (3-7, 8-12, 13-18). Construct validity was determined by comparisons with a visual analogue scale and a numerical scale with known validity. A majority of the children preferred to use the Faces scale when providing self-report of pain regardless of age. The Faces and Word Descriptor Scales are valid and reliable instruments to measure procedural pain intensity.

An extra gonadal non-gestational choriocarcinoma in a woman treated for an endometrial carcinoma.

A patient was presented with a non-gestational non-gonadal choriocarcinoma and hyperthyroidism. Five years earlier, at the age of 36, she underwent an abdominal hysterectomy with bilateral adnexectomy for endometrial carcinoma. Despite intensive treatment with multiple chemotherapy the patient died. We concluded that this non-gestational, non-gonadal choriocarcinoma was a recurrence of her previous endometrial carcinoma or a new extra (non) gonadal germcell tumor with choriocarcinoma.

Reliability and validity of preverbal pain assessment tools.

Pain assessments using three different observational pain assessment tools--the Post Operative Pain Score (POPS), the Nursing Assessment of Pain Intensity (NAPI), and the Pain Rating Scale (PRS)--were made on 98 preverbal children following surgery in an attempt to establish the reliability and validity of the three tools. Two observers (raters) scored pain intensity using each of the three instruments before and after administration of an analgesic. Interrater agreements were satisfactory on all three tools, with Interclass Correlations (ICC) ranging from .71 to .85. T tests supported the discriminant validity of all three tools at the p < .0001 level. The POPS and NAPI had internal consistency reliability alphas ranging from .79 to .88 for the POPS and .59 to .77 for the NAPI. Item analyses suggested specific revisions of the tools that might increase their reliability.

Quantifying ambulatory care activities by time and complexity.

As economic considerations increasingly drive decisions in health care, the staffing mix and nursing roles in ambulatory care are often questioned. A patient classification system that quantifies nursing activities by time and complexity can be used to assist with the difficult task of matching nursing resources with patient care needs.