Computed tomographic and magnetic resonance imaging features of canine segmental caudal vena cava aplasia.

OBJECTIVE: To describe the computed tomographic and magnetic resonance imaging features of segmental caudal vena cava aplasia and associated vascular anomalies in dogs. METHODS: A retrospective study was performed reviewing computed tomographic and magnetic resonance imaging archives of eight institutions for dogs with segmental caudal vena cava aplasia. Inclusion criteria included a computed tomographic or magnetic resonance imaging study and supportive diagnostic and follow-up information. Abdominal vessels were reviewed for size, shape, location and course (including tributaries and branches) and classified as normal, abnormal or shunt vessels. RESULTS: Ten dogs with segmental caudal vena cava aplasia were identified. In all dogs, postrenal caval blood was shunted to either a right or a left azygos vein, with seven different angiographic patterns. Affected dogs were predominantly female (70 per cent) and young (mean 2.6 years). Additional portocaval and porto-azygos shunt vessels were identified in two cases each. Computed tomographic angiography and magnetic resonance angiography depicted details of abdominal vessels including thrombus formation in one dog. CLINICAL SIGNIFICANCE: Segmental caudal vena cava aplasia is a vascular congenital anomaly in the dog that can be associated with thrombosis and portosystemic shunts. Computed tomographic angiography and magnetic resonance angiography are excellent tools to demonstrate the complex vascular anatomy and to guide treatment planning for portosystemic shunts and thrombolytic therapy.

Methaemoglobinaemia caused by hydroxycarbamide (hydroxyurea) ingestion in a dog.

A three-year-old female neutered greyhound was presented after ingestion of its owner's hydroxycarbamide (hydroxyurea) tablets. The dog was found to be cyanosed, and methaemoglobinaemia was demonstrated by co-oximetry. Therapy included methylene blue, oxygen, packed red blood cell transfusion, N-acetylcysteine and crystalloid fluids. Methaemoglobinaemia resolved within 16 hours. Granulocyte colony-stimulating factor was administered for five days in an attempt to prevent severe neutropenia. Mild delayed transient myelotoxicity was suspected. The dog made a full recovery.

Use of radiographic measurements in distinguishing myasthenia gravis from other causes of canine megaoesophagus.

OBJECTIVES: To evaluate whether dogs with megaoesophagus due to myasthenia gravis display less oesophageal dilatation radiographically than dogs with other causes of megaoesophagus. METHODS: Thoracic radiographs of 66 dogs with megaoesophagus in which concurrent acetylcholine receptor antibody titre was known were analysed retrospectively. Maximum oesophageal diameter was transformed to a "relative oesophageal diameter" using a ratio with thoracic inlet diameter. Dogs were divided into two groups according to "MG" or "non-MG" antibody status and median relative oesophageal diameter values were compared between groups and with age, weight and sex. A receiver operating characteristic plot was used to evaluate a suitable relative oesophageal diameter cut-off. RESULTS: Twenty dogs were diagnosed with myasthenia gravis and 46 with other causes of megaoesophagus. Thoracic inlet size correlated significantly with bodyweight and surface area (r(2)=0.627 and 0.669, respectively). Median values of relative oesophageal diameter for the MG group and non-MG group were 0.58 and 0.66, respectively, and these showed a small, but significant, difference (P=0.029), although there was complete overlap in the range of relative oesophageal diameter values between groups. There was no significant association between relative oesophageal diameter and sex, age or weight or significant difference in age, sex or weight between the two groups. An increased odds ratio for myasthenia gravis existed in golden retrievers and German shepherd dogs. CLINICAL SIGNIFICANCE: Relative oesophageal diameter appears to be of limited diagnostic utility in distinguishing dogs with megaoesophagus due to myasthenia gravis from those with megaoesophagus due to other causes.

Aortic and iliac thrombosis associated with angiosarcoma of skeletal muscle in a dog.

A seven-year-old, neutered male greyhound was presented with a history of episodic shifting hindlimb lameness and pain. Ischaemic necrosis of areas of the hindlimb digits and skin and a firm swelling within the medial right thigh musculature were found on physical examination. Investigation demonstrated thrombosis of the terminal aorta and right external iliac artery with ischaemic necrosis of muscular and dermal tissue distal to the sites of thrombosis. The dog was euthanased due to poor prognosis. Necropsy findings were of a poorly differentiated invasive sarcoma of the skeletal muscle of the proximal right hindlimb, thrombosis of the aorta and right external iliac artery and secondary renal glomerulopathy. Immunohistochemistry of the neoplastic tissue indicated angiosarcoma based on expression of CD31 and factor VIII-related antigen. Thrombosis was considered likely to be due to systemic hypercoagulability because of the presence of altered flow characteristics and endothelial damage in the vascular tumour bed. Aortoiliac thrombosis, paraparesis and hindlimb ischaemia are unusual sequelae of angiosarcoma in the dog.

Progressive dysphagia in a dog caused by a scirrhous, poorly differentiated perioesophageal carcinoma.

Investigation of canine dysphagia is performed by a combination of diagnostic imaging, direct visualisation of the upper gastrointestinal tract, and ancillary diagnostic testing to differentiate between structural and functional causes. Video fluoroscopy may be especially helpful. The case of a seven-year-old Border collie that presented with a history of progressive pharyngeal dysphagia is described. Fluoroscopic investigation was initially suggestive of functional pharyngeal disease, but magnetic resonance imaging and surgical exploration demonstrated the presence of a diffuse, scirrhous, poorly differentiated carcinoma with extensive oesophageal involvement. This case highlights that, in some circumstances, fluoroscopy may occasionally be of limited use in the investigation of dysphagia in the dog.

Child health interventions in urban slums: are we neglecting the importance of nutrition?

During the early part of the twentieth century, there were dramatic falls in the mortality rates in many cities in the West. The reasons for this improvement are of considerable relevance today because the conditions which prevailed at that time in cities such as New York are comparable to those prevailing in many slums of the Third World today. Some early studies linked the improvements in health, as measured by mortality rates, to a better level of nutrition. The importance of nutrition is now widely accepted and there are many studies which show the association between nutrient intake and both mortality and morbidity, and in particular between breast feeding and infant mortality rates. It is sometimes assumed that, because nutrition indicators for city populations have improved, there is no longer a major problem of malnutrition in urban areas. However, it is likely that the figures hide disparities through aggregation, and studies in slums rather than cities as a whole give a much less encouraging picture. Poverty is at the root of many of the nutritional and associated health problems, but the children who will be born over the coming decades cannot afford to wait for a new economic order to provide the solution. Through the promotion of breast feeding, education, growth monitoring and food supplementation, necessary help can be targeted at this vulnerable population.

Reconstruction of the atrophic mandible.

Because atrophy of the jaws in edentulous patients is a major health problem, how best to reconstruct the atrophic mandible is a dilemma that frequently confronts the medical and dental professions. After loss of the natural dentition, the reduction of the residual ridges is progressive, irreversible, and cumulative. The cause and pathogenesis of mandibular atrophy is discussed. In the evaluation of a patient, the amount of residual bone at the symphysis should be measured on the lateral cephalometric radiograph as an aid to treatment planning. This measurement allows the degree of atrophy to be classified as minor, moderate, or severe. The current techniques to rehabilitate the edentulous mandible, including relative and absolute heightening techniques and implants, are reviewed with illustrative examples. A modification of a previous absolute heightening osteotomy technique utilizing pedicle bone flaps, is presented.

Supervising Community health Workers in Community-Based Delivery of Primary Health/Family Planning Services: Experiences in Mexico, 1977-1982.

The supervision of CHWs in the Mexican Rural Health Program (1977-82) illustrates a wide range of problems and strengths because it was developed within a program based on a strong political mandate to deliver services to an extremely large, as well as culturally and geographically diverse population. This article presents an in-depth perspective on the issues involved in the supervision of community health workers with a focus on the myriad roles and responsibilities which are expected from supervisory personnel. The information and observations which are offered come from program evaluation materials as well as the long-term, first hand experience of the authors with the program discussed.

Direct nutrition intervention and the control of diarrheal diseases in preschool children.

PIP: This is a report of the reduction in frequency of diarrheal disease in malnourished school children, which was an unanticipated result of a nutrition intervention program in Candelaria, Colombia, during 1964-65. In a late 1963 baseline study all preschool children were weighed and measured and the mothers interviewed. Mothers of the malnourished were invited to participate in a supplementation program. Weekly records were kept of the episodes, and diarrheal disease decreased in the 182 children observed for a full calendar year. Each malnourished child was given 1 pound of dried skimmed milk (DSM) per week. In the 6-week program the mothers were educated about food and nutrition. At monthly intervals the children were weighed and measured. Among the 101 children with first degree malnutrition at the start of the program, almost two-thirds had improved; of the 72 with second degree malnutrition, three-fourths improved; and, all of the 9 with third degree malnutriton improved after the first year. Mothers commented that after receiving supplement for about 6 weeks their children had less diarrhea. Exclusive breastfeeding plays a protective role against diarrhea in the early months of life. The association between nutritional status and diarrheal disease is stronger than that of environmental sanitation.^ieng

Skylab ultraviolet stellar astronomy experiment S019.

An objective-prism stellar spectrograph of 15-cm aperture was flown on all three Skylab missions. The wavelength region from 1300 A to 5000 A was covered by a special optical system containing a combination of reflecting telescope optics, a CaF(2) objective prism, and an achromatized field corrector lens system of CaF(2) and LiF. Observations of 188 star fields, each covering 4.0 degrees 5.0 degrees , were conducted at the Skylab antisolar airlock with the aid of an articulated mirror system (AMS) which allowed acquisition within 30 degrees degrees 360 degrees band of the sky.

Motivation medical students in the Ramathibodi Community Health Program.

PIP: The faculty of Medicine of Mahidol University in Bangkok organized a community health program for medical students composed of 5 courses: health and demographic survey; analysis of community health programs; planning of community health care; clerkship in community health and internships in community health. These courses are organized to provide first hand experience for the student by enabling him to do field work. This consists of actually analyzing population problems, understanding the characteristics of the people whom the programs are designed to serve, and providing realistic solutions rather than theoretical ones. The effectiveness of this approach is best measured by the number of students who are engaged in voluntary projects designed to contribute to a solution of the population problem, and the interest they show in the community health program.^ieng

Editorial: Expanded MCH services.

PIP: The family planning aspect of health care effectiveness in maternal and child health programs (MCH) can be predicted thorough the use of the multiplicative mathematical model where delivery systems, technology and elgible population are interacting factors. Additionally, health personnel are considered a key factor in the delivery system and an attempt is made to identify this factor through a model which demonstrates that the active learning by personnel is a crucial element in determining effectiveness of a program. Equations are also used to determine the effectiveness of both the nutrition component and foreign assistance in MCH family planning programs.^ieng