Resolving the common clinical dilemmas of syphilis.

The diagnosis and treatment of syphilis can present difficult dilemmas. Serologic tests can be negative if they are performed at the stage when lesions are present, and the VDRL test can be negative in patients with late syphilis. Cerebrospinal fluid examination is not required in patients with primary or secondary disease and no neurologic signs or symptoms, but it may be warranted in patients with late latent syphilis or in whom the duration of infection is unknown. Patients with penicillin allergy can be treated with alternative regimens if they have primary or secondary syphilis. Penicillin is the only effective drug for neurosyphilis; oral desensitization should be accomplished before treatment of penicillin-allergic patients. Other dilemmas may be encountered in the treatment of patients who have concurrent human immunodeficiency virus infection.

Naturally acquired leptospirosis in 36 dogs: serological and clinicopathological features.

Case records of 36 dogs with confirmed leptospirosis diagnosed at the New York State College of Veterinary Medicine from 1980 to 1995 were reviewed retrospectively, and clinical, serological and pathological findings were recorded to characterise the epidemiology of this disease in upstate New York. Titres were directed predominantly against serovars grippotyphosa and/or pomona in 31 of 34 dogs. Convalescent titres were measured for 53 per cent of dogs. The most common clinical presentation was acute renal failure. Increased liver enzyme activity was documented in 22 of 36 dogs. It is clear from this study that Leptospira pomona and grippotyphosa are important pathogens capable of causing severe renal and hepatic injury in dogs.

Calcipotriol toxicity in a dog.

A six-month-old Labrador retriever was presented for investigation of acute polyuria, polydipsia and haematemesis six hours following ingestion of a tube of the topical antipsoriatic vitamin D analogue, calcipotriol. Transient hypercalcaemia, azotaemia, proteinuria, thrombocytopenia and ventricular arrhythmias ensued. Abdominal ultrasonography and echocardiography revealed evidence of diffuse soft tissue mineralisation. Despite 13 days of intensive supportive care, the dog was euthanased due to continued haematemesis and anorexia. Necropsy confirmed mineralisation and necrosis of multiple organ systems consistent with vitamin D toxicity.

Regulation of veterinary biological products for fish in the United States.

The USDA regulates veterinary biological products for fish in the U.S. to ensure that they are pure, safe, potent and efficacious, and not worthless, contaminated, dangerous, or harmful. To market a biological, USDA establishment and product licences (for U.S. biologicals manufacturers) or a USDA permit (for U.S. representatives of biologicals manufacturers abroad) are required. The USDA will issue the appropriate licences or permit following submission of acceptable documentation by the applicant, inspection of production facilities and confirmatory testing by the USDA.

Heat-tempered composite resin laminate veneers.

Laminate veneers have rapidly become the restoration of choice for the conservative esthetic restoration of anterior teeth. The historical development of the process for veneering teeth is presented, and the significant advancements since the introduction of the concept nearly 60 years ago are highlighted. Heat-tempered composite resin laminate veneers are evaluated, including their advantages and disadvantages relative to bonded porcelain veneers. A new technique for the creation of one-appointment heat-tempered hybrid composite resin laminate veneers is discussed. Recent research into the critical features and properties of heat-tempered composite resin inlays and onlays and laminate veneers is reviewed, as are suggestions for technique improvements based on scientific investigations.

Direct oven-tempered hybrid composite-resin laminate veneers.

The difficulty in achieving optimal aesthetics of the single-tooth indirect laminate veneer has prompted the author to develop a direct technique for fabricating oven-tempered hybrid composite resin veneers. These restorations exhibit excellent physical properties, marginal integrity, and aesthetics.

Pneumocystis carinii pneumonia studied by gallium-67 scanning.

The validity and reliability of gallium-67 (Ga-67) scanning for diagnosis and follow-up of Pneumocystis carinii pneumonia (PCP) were assessed in 34 patients thought to have pulmonary complications of acquired immunodeficiency syndrome (AIDS). Overall sensitivity was 94% and specificity 74%. Among patients with normal or equivocal chest radiographs at the time of admission, sensitivity was 86% and specificity 85%. The authors consider Ga-67 scanning a valid and reliable adjunct in the diagnosis of PCP in AIDS patients with respiratory symptoms when the chest radiograph is normal or equivocal.

Lyme disease in northern California.

Lyme disease is a recently described clinical entity with cutaneous, neurologic, articular and cardiac manifestations. Since the original description of the disease in 1977, more than 500 cases have been reported. Although the vast majority of patients have been from the area near Lyme, Connecticut, we have seen four patients from northern California with various aspects of Lyme disease. This diagnosis should be considered in patients who have traveled to tick regions and who have a distinctive skin lesion (erythema chronicum migrans). Clinical and epidemiologic evidence suggests the disease is transmitted by a tick, lxodes dammini in the eastern United States, lxodes pacificus in the West and lxodes ricinus in Europe. The etiologic agent, a new spirochete, may have been recently discovered.

Histocompatibility antigens in progressive systemic sclerosis (scleroderma).

A study was undertaken to determine the distribution of major histocompatibility (HLA) antigens in progressive systemic sclerosis (PSS) (scleroderma). A total of 106 patients with PSS and 208 normal controls were tested for the presence of 18 different HLA antigens by the microcytotoxicity technique. These patients were equally divided between patients with classical diffuse scleroderma (53 patients) and those with the CREST syndrome variant of the disease (53 patients). When the P values were multiplied by 18, to correct for the number of antigens studied, no significant alteration in the frequency of any HLA antigen was found for the entire group of scleroderma patients or for either of the two subpopulations.