Approaches to contact investigations in Texas.

Tuberculosis (TB) spreads when family and social contacts breathe the air exhaled by someone with active TB disease. Contact investigation is the most appropriate strategy to interrupt the transmission and subsequent development of TB. One of the problems associated with contact investigations in an area with a very diverse population has been the inability of investigations to adapt their methods of approach to the different circumstances of each person with TB disease. Through interviews and group discussions with public health field workers and local TB program managers across Texas, the authors have been able to gather information on how contact investigation practices can be customized to overcome barriers specific to different populations in the state and generate a productive outcome. Variables such as culture, language, risk factors, and various settings may require a different investigational approach than the standard, traditional approach to contact investigation. It is anticipated that the concept of customizing contact investigations to meet the needs of specific populations and circumstances will become the practice worldwide, and will be a useful tool in the management of contact investigations.

Retarded and excessive development of skin appendages in fetal lambs in response to thyroidectomy before wool follicle appearance.

The impact on wool follicles of development in an athyroid environment was studied in a series of twin fetal lambs by surgically thyroidectomizing one of each pair before the appearance of follicle buds and comparing development of epidermal appendages in it with their development in the normal co-twin. Thyroidectomy was undertaken at 51 to 54 days' gestation, i.e. after approximately one-third of the gestation period. Each treated fetus was then replaced in the uterus, allowing pregnancy to continue. Eight pairs of twins were removed at intervals from 67 to 122 days' gestation and skin samples from the thyroidectomized and the intact twins were compared. Micromorphometric examination of the samples was used to assess quantitatively the effects of thyroid deprivation on wool follicle development. In thyroidectomized fetuses there was a failure of keratinization in primary wool follicles, an absence of secondary follicles, a tendency to excessive follicular branching and sweat gland development, and a paucity of sebaceous gland formation. The density of wool follicles was substantially increased, but the mean cross-sectional area of these follicles was reduced. The effects of very early thyroidectomy imply that the thyroid plays a role in the stimulation and regulation of wool follicle differentiation. To test the reversibility of the effects observed in the skin of thyroidectomized fetuses, grafts from these animals were transplanted to normal, young fetal lambs. Subsequent examination of grafted skin revealed that complete keratinization had occurred but that none of the other abnormal features had been reversed.

An immunofluorescence test to determine the occurrence of type II collagen in muscle biopsies from cattle with rectovaginal constriction.

Type II collagen occurs in the muscles of rectovaginal constriction (RVC) affected and carrier cattle but not in normal cattle. Muscle biopsies from known RVC affected and carrier cattle and normal cattle were examined for the presence of Type II collagen using affinity purified goat anti-collagen II serum in a fluorescent antibody test. Type II collagen was consistently found in RVC affected animals (22 of 23 samples score positive). Rectovaginal constriction carrier animals had variable staining for the Type II collagen (25 of 47 samples scored positive). Some positive staining was also observed in the control animals (8 of 34 samples scored positive). Because of the variable occurrence of Type II collagen, the value of fluorescent antibody staining to identify RVC carrier animals is uncertain.

Comorbid psychiatric disorders in elderly medical patients: a 1-year prospective study.

Cross-sectional studies have revealed a high prevalence of comorbid psychological problems among geriatric medical patients, a low rate of detection by primary care professionals, and greater psychosocial dysfunction and poorer physical health associated with comorbidity. Less is known about the course and impact of psychiatric comorbidity. Psychiatric status, physical health status, psychosocial functioning, and health care utilization for a sample of geriatric patients (n = 102) were assessed on admission to a medical hospital and again one year later. Results revealed a very stable and high prevalence of comorbid psychological problems, especially depression, a low rate of treatment by mental health professionals, greater physical impairment consistently associated with psychiatric comorbidity, but few health care utilization differences. A closer look at depression revealed that it typically began in late life and did not readily resolve.

Modified transfixation pinning of compound radius and ulna fracture in a heifer.

A 405-kg heifer sustained a compound fracture of the distal portion of the radius and ulna after being hit by a car. The fracture was thoroughly debrided, lavaged, and reduced with the heifer under general anesthesia. The fracture was immobilized with a modified walking cast, using 2 fully threaded 6.4-mm (outside diameter) Steinmann pins placed through the proximal portion of the radius. The pins were incorporated into a full-limb fiberglass cast, and a 0.5-cm X 2.25-cm aluminum walking bar was positioned medially and laterally on the limb. The modified walking cast was removed after 7 weeks, and the fracture healed without complication. The transfixation pins and aluminum walking bar helped reduce the strong compressive and rotational forces at the fracture site. The modified walking cast can potentially be used for fixation of a variety of fractures in large animals.

Breeding soundness of beef bulls after circumcision: 33 cases (1980-1986).

Case records of 33 beef bulls that had preputial prolapses and underwent circumcisions were reviewed. Data retrieved included age, breed, duration of preoperative medical treatment, complications of surgery, length of time from surgery to first breeding, ability of bull to copulate, duration of active breeding, and complications resulting in breeding unsoundness. The mean age of all bulls was 3.5 years (1 to 7 years). Breeds represented included Santa Gertrudis (n = 13), Beefmaster (n = 8), Brangus (n = 7), Brahman (n = 4), and Angus (n = 1). The mean duration of medical treatment before surgery for all bulls was 16.4 days (2 to 38 days). There was no statistically significant difference between the mean duration of medical treatment before surgery between bulls that became breeding sound (16 days), compared with those that were breeding unsound (19 days). However, bulls requiring more than 14 days of medical treatment before surgery were approximately 3 times (relative risk, 2.8) more likely to develop postoperative complications than those bulls requiring 14 days of treatment or less. Eleven bulls (33%) developed one or more postoperative complications. The complications resolved in 4 bulls, but 7 were never able to breed. Of these 7 bulls, 4 had problems directly related to the circumcision, 2 had extensive fibrosis of the prepuce already present at surgery, and 1 was discharged from the hospital with no apparent complications but was never able to breed. Twenty-five of the 33 bulls (76%) were breeding sound for 1 or more years after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Head and neck oncology service--one year's work.

A head and neck oncology service serving the Islington and Haringey District was organized in 1985. It is based at the Whittington and Royal Northern Hospitals and is conducted in conjunction with the combined clinic of the Head and Neck Oncology Group at the Royal Ear Hospital (University College Hospital). This paper presents a survey of the first year's experience during which 29 new cases of head and neck cancer were seen.

Persistent urachal remnant causing intestinal strangulation in a cow.

A persistent urachal remnant causing small intestinal strangulation was found on exploratory laparotomy in a 2-year-old cow with colic. The persistent urachus consisted of a thin cord-like band that was attached ventrally to the umbilical region and caudally to the apex of the bladder. The band had formed an internal loop and had strangulated 6 to 8 cm of the distal portion of the ileum. The persistent urachus was detached manually at the umbilicus, ligated at the apex of the bladder, and removed; intestinal resection was not necessary. The urachal remnant was probably a congenital abnormality that may have become stretched during pregnancy, forming an internal hernial loop.

Frontal sinus abscess and secondary orbital cellulitis.

Despite modern antibiotics, frontal sinus abscess (and secondary orbital cellulitis) remains relatively common and potentially life-threatening. The declining incidence of chronic middle ear disease in the UK has made it one of the commonest causes of intracranial abscess. The speed with which suppuration can penetrate the sinus walls remains poorly understood and a research challenge. Management is best supervised by an ENT surgeon because the key decision is the timing of sinus surgery. The ENT surgeon, nevertheless, must be alert to the indications for consultation with neurosurgical colleagues. This paper aims to give an illustrated account of the clinico-pathological features and current management.

A retrospective review of maternal and child health services at the Albert Schweitzer Hospital in rural Haiti.

PIP: For the past 25 years the Albert Schweitzer Hospital in Deschapelles, Haiti has been providing a wide range of maternal and child health services to the people of its rural district. Numerous special services for mothers and children have been added over the years, but these began to realize considerably greater potential with the creation of the hospital's Community Health Department in 1967. This department has carried out numerous preventive health programs and services designed to accommodate these groups' special health needs. Attention is directed to neonatal tetanus control; surveillance, treatment, and prevention of malnutrition; and other maternal and child health services (school programs, immunization activities, prenatal and postnatal care, family planning, the midwives' program, the "cord-cut" unit, the low birth weight project, and dispensaries and health agents). In 1967 the hospital began to develop programs especially designed to control neonatal tetanus. Communities were immunized systematically. By establishing outdoor immunization clinics at the hospital and at major marketplaces in the district and by working with traditional midwives, these programs were responsible for a sharp decline in the incidence of neonatal tetanus. Malnutrition has remained the most frequently occurring health problem among children in the hospital district. Several services and programs have been established throughout the years to meet the identified needs. These include the following which are described: the nutrition clinic; courtyard education; "weigh-ins;" nutrition recovery centers; the 3-day center at Deschapelles; nutrition intervention and case follow-up program; and malnutrition treatment. The hospital's family planning program has gradually increased its use of community education to reach the population and to try to gain acceptance of the need to space and limit births. This community education has been disseminated by dispensaries, mobile health team workers, public health nurses, and physicians. Implementation of immunization, health surveillance, health education, and improved tuberculosis control activities have produced gratifying reductions in overall maternal and child morbidity and mortality in the Schweitzer hospital district.^ieng

Oviduct (uterine tube) transport of ova in the cow.

Normal oviduct (uterine tube) transport of ova was studied in 12 nulliparous heifers oophorosalpingohysterectomized at various times (range, 26 to 85.25 hours) after the end of estrus. The mean oviduct length +/- SEM was 19.7 cm +/- 0.38. The means of left and right oviduct length were not different (P greater than 0.10). The ampulla and isthmus of the oviduct could be indentified grossly by a definite reduction in lumen size and represented 0.66 and 0.34 of the total oviduct length, respectively. The oviduct ipsilateral to ovulation was divided into eight equal segments. Each segment and the uterine horn were flushed with saline solution. An ovum or zygote was recovered from the oviduct of nine heifers. A zygote was surgically recovered from the uterus of one heifer at 76.75 hours after the end of estrus. An ovum or zygote was not recovered from two of the heifers. A significant linear relationship (P less than 0.01) existed between the estimated time after ovulation and the distance the ovum or zygote had traveled. Therefore, the ovum or zygote in these heifers was transported through the oviduct at a constant rate.

Diabetes insipidus in a cow.

Diabetes insipidus was diagnosed in a 6-year-old Holstein-Friesian cow with a history of recurrent fever, ketosis, lymphadenopathy, and inappetence. The diagnosis was based on the clinical findings, response to exogenous vasopressin, and lack of urine concentration in a water deprivation test. The disease gradually regressed over a period of 1 year and did not recur.