Multiple pathological fractures and delayed union associated with lead exposure in a German Shepherd Dog.

CASE REPORT: An 8-year-old 40.8-kg intact male German Shepherd Dog was evaluated for bilateral antebrachial fractures. Radiographs revealed osteopenia and comminuted proximal diaphyseal fractures of the left radius and ulna, and proximal articular fracture of the right ulna. A dual energy X-ray absorptiometry scan confirmed decreased bone mineral density. Bone mineral analysis collected at the time of definitive surgical repair demonstrated high lead concentration. Analysis further demonstrated normal bone calcium and phosphorus concentrations. Serum lead concentration was normal. The left radial and ulnar fractures were surgically stabilised with an external fixator. The right ulnar fracture was splinted. The left antebrachial fractures were palpably unstable at 12 weeks after surgery. Moderate callus formation and incomplete bone union were present at 17 weeks postoperatively. The dog was re-presented 15 months later for right metacarpal and left metatarsal fractures, which were managed conservatively. Complete bone union of the right radial and ulnar fractures was not present at that time. CONCLUSION: Excessive lead accumulation in bone should be considered as a differential diagnosis for increased susceptibility to pathologic fracture and delayed fracture healing in dogs.

Coronary stent placement as a bridge to coronary artery bypass surgery in an unstable, anemic Jehovah's Witness patient: a case report and review of bloodless surgery techniques.

Bloodless cardiac surgery would be optimal for all patients undergoing major or complex heart surgery; however, for Jehovah's Witnesses it involves a religious law and is fundamentally mandated. In this context, we review a case of unstable angina with associated anemia requiring catheterization and definitive intervention in a Jehovah's Witness patient. Coronary stenting to stabilize the acute coronary syndrome is described with definitive total revascularization performed by coronary artery bypass graft surgery after utilizing erythropoietin and aggressive blood conservation techniques.

Cryptographic protection of health information: cost and benefit.

Medical, legal, and economic reasons inevitably force health care establishments to apply more and more open distributed IT systems rather than the less flexible and more expensive mainframes. Managing, for example, electronic patient records by various users at different locations by means of large scale client server systems requires new security provisions for storing, archiving and communicating those data. Using an analogy, data processing is being changed from railroads to highways. Formerly, only one engine-driver was responsible for the security of a whole train whereas now the car-drivers themselves are responsible each for his own car. Unless the cars are equipped with suitable security mechanisms like breaks and safety belts this change endangers individuals within and outside the cars. Cryptography provides many of the relevant security mechanisms for open distributed health care IT systems. Indeed, suitable cost effective cryptographic products are available but are rarely found in health care IT systems. The reason is more political than economic, diverging national security interests in the EU have prevented strong security in public telecommunication infrastructures arguing that, e.g. criminals would profit, too. The resulting uncertainty of investments delays the development, standardisation and installation of cryptographic solutions.

[Questionnaire to assess perception of chronic disease in couples. Perceptual pattern in coronary patients and their partners]. / Fragebogen zur Wahrnehmung chronischer Krankheit bei Paaren. Wahrenehmungsmuster bei Koronarpatienten und deren Partnerinnen.

103 male patients with coronary heart disease and their partners filled out the Questionnaire about the Perception of an Illness and its Consequences (Fragebogen zur Wahrnehmung der Krankheit und ihrer Folgen, FWKF) which is available for both the patient and his partner. Factor analyses were done separately for the items of both FWKF versions, which examine with the consequences of coronary heart disease. Four interpretable factors were calculated, which are highly congruent in both versions: "dependency vs. independency", "resignation vs. hope regarding the physical condition", "positive vs. negative anticipation regarding social resonance" and " self and partner orientation vs. achievement". Four scales were derived which enable a diagnosis of the perception and coping modi of the patient and his partner and to draw conclusions about the partner interaction. Couples could be identified where both partners take similar extreme positions. They thus leave themselves little room for development. The significance of these results for more well-directed and therefore more improved psychosocial counselling of coronary patients and their partners is discussed.

A biochemical characterization of human breast tumors.

The activities of PHI, LDH and LDH isoenzymes were examined in 45 samples of human breast tissue. There were 25 carcinomas, 10 fibroadenomas and 10 nontumor tissue samples. In the group of nontumor breast tissue, values were as follows: PHI (X = 574 SD = 69), LDH (X = 634 SD = 91), LDH5/LDH1 (X = 0.42 SD = 0.23); in the benign group, PHI (X = 425 SD = 95), LDH (X = 59 SD = 188), LDH5/LDH1 (X = 0.55 SD = 0.38); and in the malignant tumor group, PHI (X = 2871 SD = 1350), LDH (X = 3108 SD = 1417), LDH5/LDH1 (X = 3.33 SD = 0.95). The enzyme activities of nontumor and benign tissue were statistically similar, but when these parameters were compared with the enzyme values of malignant tissue, there was a significant statistical difference. Based on these results, it is possible to establish a biochemical criterion for malignancy with the PHI and LDH activity levels greater than 720 U/g and the LDH5/LDH1 ration greater than 1.3. By using this criterion, the examined specimens can be categorized as nontumor or benign in one group and malignant in another group. This corresponds to the histiopathologic system of classification.