Retrospective study of gross and histopathologic lesions associated with closed chest cardiopulmonary resuscitation in dogs.

OBJECTIVES: To investigate and characterise the incidence of iatrogenic complications secondary to closed chest cardiopulmonary resuscitation in dogs. MATERIALS AND METHODS: Necropsy reports and histologic sections of tissues were retrospectively examined from 180 dogs that had received closed chest cardiopulmonary resuscitation to determine lesions associated with resuscitation. RESULTS: The most common complication was pulmonary haemorrhage (81/163, 49.7%, 95% confidence interval: 42.1 to 57.3), although only nine dogs had pulmonary haemorrhage of at least moderate severity. Liver fractures occurred in 16 of 180 cases (8.9%, 95% confidence interval: 5.5 to 14.0). Blood loss of >15% of blood volume into the abdomen and/or thorax occurred in 13 of 180 cases (7.2%, 95% confidence interval: 4.2 to 12.1). CLINICAL SIGNIFICANCE: Significant haemorrhage secondary to cardiopulmonary resuscitation may decrease the chances of achieving the return of spontaneous circulation or may cause or compound ischemic damage to critical organs if the return of spontaneous circulation is achieved. Following successful cardiopulmonary resuscitation, animals should be screened for cavitary or pulmonary haemorrhage, as significant haemorrhage could be a factor in recurrence of cardiac arrest.

Systematic mapping of icosahedral short-range order in a melt-spun Zr36Cu64 metallic glass.

By analyzing the angular correlations in scanning electron nanodiffraction patterns from a melt-spun Zr(36)Cu(64) glass, the dominant local order was identified as icosahedral clusters. Mapping the extent of this icosahedral short-range order demonstrates that the medium-range order in this material is consistent with a face-sharing or interpenetrating configuration. These conclusions support results from atomistic modeling and a structural basis for the glass formability of this system.

Randomized, blinded comparison of epinephrine and vasopressin for treatment of naturally occurring cardiopulmonary arrest in dogs.

BACKGROUND: Administration of epinephrine during CPR is recommended for treatment of cardiopulmonary arrest (CPA) in dogs. Administration of epinephrine during CPR might be associated with deleterious adverse effects. Vasopressin has been studied for use in CPR as an alternative. HYPOTHESIS: That administration of vasopressin instead of epinephrine with standard CPR techniques will result in improved outcome. ANIMALS: Seventy-seven client-owned dogs identified in the ER/ICU with CPA were eligible for inclusion. METHODS: Randomized, prospective clinical study. Dogs were randomized to receive epinephrine (0.01-0.02 mg/kg) or vasopressin (0.5-1 U/kg) in a blinded fashion. Attending veterinarians were asked to adhere to standardized CPR protocol for the 1st 6 minutes of CPR, during which time doses of the study drug were administered at 3-minute intervals. RESULTS: A total of 60 dogs completed this study with 31 receiving epinephrine and 29 receiving vasopressin. Overall rate of return of spontaneous circulation (ROSC) was 60% (36/60), 32% (19/60) of dogs survived to 20 minutes, 18% (11/60) survived to 1 hour. No difference was seen in rates of ROSC between the 2 groups (P = .20). Dogs receiving epinephrine were more likely to survive to 1 hour (odds ratio 5.86; 95% CI: 1.19-28.95) than those receiving vasopressin (P = .027). CONCLUSIONS AND CLINICAL IMPORTANCE: ROSC was similar in dogs receiving epinephrine or vasopressin. In this study, a survival advantage at 1 hour was seen in those animals receiving epinephrine. No advantage of routine use of vasopressin over epinephrine was detected. Further studies are required to examine subgroups of dogs that might benefit from specific interventions.

Molecular epidemiology of cystic fibrosis-linked Burkholderia cepacia complex isolates from three national referral centres in Ireland.

AIMS: Burkholderia cepacia is a Gram-negative bacterium associated with increasing morbidity and mortality and is readily transmitted among infected cystic fibrosis (CF) patients. The B. cepacia complex consists of five distinct subgroups, termed genomovars. A collection of 17 presumptive B. cepacia isolates, obtained from three national CF referral centres located in different geographical regions in Ireland, was studied. The aim of this study was to investigate these isolates using molecular subtyping protocols for evidence of genetic relationships and for the presence of antibiotic resistance-encoding class 1 integron structures. METHODS AND RESULTS: Genomovar classifications were assigned to each isolate based on HaeIII enzyme profiles of their recA locus. Genetic relationships among this collection were also assessed after restriction fragment length polymorphism (RFLP)-mediated analysis of the 16S rDNA locus and DNA amplification fingerprinting (DAF). The surface expression of the cable pilus gene (cblA) may facilitate an early step in the infection process. All isolates were tested by amplification strategies for this marker. Burkholderia cepacia is known to be resistant to several antimicrobial agents. Resistance typing showed that the majority were resistant to three or more common antimicrobial agents. Five of the 17 isolates were resistant to sulphonamide, a characteristic linked with the presence of class 1 integrons. Gene cassettes containing beta-lactamase (oxa) and aminoglycoside acetyltransferase (aac(6')-1a) encoding genes were identified by polymerase chain reaction amplification. CONCLUSIONS: Most of the isolates in this study were classified as genomovar III and were indistinguishable based on their corresponding 16S rDNA-RFLP profiles, whilst DAF further subtyped the collection. The cblA marker was identified in 47% of the isolates, many of which clustered in the genomovar III group. Class 1 integrons with recombined gene cassettes containing bla-OXA and aac(6')-1a genes were identified. SIGNIFICANCE AND IMPACT OF THE STUDY: This study demonstrates the application of molecular methods to investigate B. cepacia, a well-recognized human pathogen, cultured from Irish CF patients. Genomovar III was the most common genomic type identified. DNA fingerprinting further subtyped the latter isolates, facilitating a more detailed description of the molecular epidemiology. Drug resistance in these organisms can be explained, at least in part, by the presence of class 1 integrons. Development of targeted infection control strategies could be facilitated using these applied methods.

7-Methoxybenzofuran-4-carboxamides as PDE 4 inhibitors: a potential treatment for asthma.

The synthesis and pharmacological profile of a novel series of 7-methoxybenzofuran-4-carboxamides is described. Some of these compounds were found to be potent inhibitors of phosphodiesterase type 4 (PDE4).

A pug-nosed crocodyliform from the Late Cretaceous of Madagascar.

Although the image of crocodyliforms as 'unchanged living fossils' is naive, several morphological features of the group are thought to have varied only within narrow limits during the course of evolution. These include an elongate snout with an array of conical teeth, a dorsoventrally flattened skull and a posteriorly positioned jaw articulation, which provides a powerful bite force. Here we report an exquisitely preserved specimen of a new taxon from the Late Cretaceous of Madagascar that deviates profoundly from this Bauplan, possessing an extremely blunt snout, a tall, rounded skull, an anteriorly shifted jaw joint and clove-shaped, multicusped teeth reminiscent of those of some ornithischian dinosaurs. This last feature implies that the diet of the new taxon may have been predominantly if not exclusively herbivorous. A close relationship with notosuchid crocodyliforms, particularly Uruguaysuchus (Late Cretaceous, Uruguay) is suggested by several shared derived features; this supports a biogeographical hypothesis that Madagascar and South America were linked during the Late Cretaceous.

Aryl sulfonamides as selective PDE4 inhibitors.

A series of novel selective phosphodiesterase 4 (PDE4) inhibitors has been developed which displays activity both in vitro and in vivo. These compounds possess good selectivity for the catalytic site of PDE4 over the high affinity Rolipram binding site. In vivo studies demonstrate a reduced propensity to display the emetic side effects which are commonly observed with PDE4 inhibitors.

Senior house officers in medicine: postal survey of training and work experience.

OBJECTIVES: To describe working conditions for senior house officers in medicine in Scotland and to relate these to the quality of clinical training they receive. DESIGN: Postal questionnaire survey. SUBJECTS: All senior house officers in medicine and related specialties in post in Scotland in October 1995 (n = 437); 252 (58%) respondents. MAIN OUTCOME MEASURES: Questionnaires covered hours, working patterns, measures of workload, an attitudes to work scale, and experience of education and training. RESULTS: In the week before the questionnaire, doctors on rotas had worked a mean of 7.4 (95% confidence interval 5.8 to 9.0) hours in excess of their contracts, compared with 3.7 (2.0 to 5.5) hours for those on partial shifts. The most common reason for this was "the needs of the patients or the service." Those on partial shifts reported significantly less continuity of care with patients than those on rotas (Mann-Whitney U test, z = -4.2, P < 0.0001) or full shifts (z = -2.08, P = 0.03). Doctors in general medicine reported significantly higher measures of workload (number of acute admissions, number of times called out, and fewest hours' uninterrupted sleep) than those in subspecialties. Consultants' clinical teaching and style of conducting a ward round were significantly related to factors extracted from the attitudes to work scale. CONCLUSIONS: The quality of senior house officers' training is detrimentally affected by a variety of conditions, especially the need for closer support and supervision, the need for greater feedback, and the lack of time that consultants have to dedicate to clinical training. Efforts should be made to improve these conditions and to reinforce a close working relationship between trainee and supervising consultant.

Traveling healthy: a guide for counseling the international traveler.

Pretravel medical history and itinerary review coupled with education and counseling precedes a mutual plan between the provider and the traveler for appropriate immunizations, prophylaxis for malaria, and precautions against travelers' diarrhea. This article provides a useful tool for taking a travel history, an overview of the immunizations recommended, and behavioral practices for prevention of illness and injury. Traveler-friendly resources are available for pretravel advice, health care abroad, emergency medical transport, special needs travelers, and U.S. State Department advisories. Planning should begin as early as possible to allow time for vaccine series, separation of vaccines to avoid adverse interactions, as well as prophylactic antimalarials that need to be initiated in advance of travel. Travelers with special needs should prepare ahead for access to care, medications, and medical identification. Returning travelers need to be counselled to report their travel to their provider if seeking medical attention post travel.

Effect of nibbling versus gorging on cardiovascular risk factors: serum uric acid and blood lipids.

Nibbling has been reported to decrease serum cholesterol under fasting conditions, as well as the incidence of cardiovascular disease. It has been suggested that these effects are partly attributable to reduced concentrations of serum insulin, which are also observed. However, data on the effects of nibbling on serum lipids throughout the day are not available, nor is it known how nibbling affects serum uric acid as a further insulin-related risk factor for cardiovascular disease. We have attempted to address these issues. Seven healthy men consumed identical diets in a randomized crossover design either as three meals daily (control) or as 17 meals daily (nibbling) for 2 weeks. On day 13, serum lipid levels were measured over the course of the day (12 hours) together with the 24-hour urinary excretion of mevalonic acid as an indicator of hepatic cholesterol synthesis. Concentrations of uric acid in serum and 24-hour urinary excretion of uric acid were also determined. Mean (+/- SE) percent treatment differences in day-long total, low-density lipoprotein (LDL), and non-high-density lipoprotein (HDL) cholesterol, and apolipoprotein (apo) B were significant, with lower values on the nibbling diet as compared with the control diet (8.1% +/- 1.6%, P = .002; 12.2% +/- 2.6%, P = .005; 10.1% +/- 1.6%, P < .001; and 9.9% +/- 2.6%, P = .008, respectively). No significant difference was seen in the total to HDL cholesterol ratio or in urinary mevalonic acid excretion.(ABSTRACT TRUNCATED AT 250 WORDS)

Faciohypoglossal anastomosis: does the morphology of the facial nerve affect the functional result?

We report the results of a histological study of facial nerve specimens obtained at the time of faciohypoglossal anastomosis. We examined sections from 24 patients using light and electron microscopy in order to determine the extent of the degenerative process with time and its relationship to the functional results of the anastomosis. We graded the histological features associated with degeneration, regeneration, and fibrosis on an ordered nominal scale from 0 to 3 and correlated them with duration of facial palsy and postoperative facial function. There was no histological evidence of increasing collagenosis or fibrosis with duration of facial palsy, and endoneural fibrosis was a very infrequent finding. There was no evidence that the relative numbers of endoneural fibrocytes or the degree of collagenosis had any bearing on the functional result. The presence of large numbers of endoneural tubes, containing nonmyelinated axons, showed a positive correlation with the postoperative facial function, whereas the presence of active axon degeneration showed a negative correlation.

The continuing dental education (CDE) activities of a regional cohort of Irish dentists--a baseline study.

The need for continuing dental education (CDE) throughout one's career is becoming increasingly accepted by the modern practitioner. The current paper is part of a longitudinal investigation of the various conceptual, practical and attitudinal aspects of CDE. (Based on the responses of a representative sample of 146 dentists, it documents the level of participation in CDE among practitioners in the South and Mid-West regions of Ireland, at a baseline examination). Only 41% of respondents belonged to more than one professional association, while 55% subscribed to more than one journal. The Irish Dental Association and the present journal dominated these statistics. There was a generally low level of involvement in elements of CDE, such as attendance at scientific conferences, professional courses and occasional meetings. There was a high degree of consistency in the respondents' participation in CDE-related activities. Thus dentists who belonged to a number of organisations and subscribed to various journals, also tended to more frequently attend relevant conferences, courses and meetings. With some exceptions, specialist and hospital-based dentists were more likely to be involved in CDE activities.

Beneficial effect of a low glycaemic index diet in type 2 diabetes.

Low glycaemic index foods produce low blood glucose and insulin responses in normal subjects, and improve blood glucose control in Type 1 and well-controlled Type 2 diabetic patients. We studied the effects of a low glycaemic index diet in 15 Type 2 diabetic patients with a mean fasting blood glucose of 9.5 mmol l-1 using a randomized, crossover design. Patients were given pre-weighed diets (59% energy as carbohydrate, 21% fat, and 24 g 1000-kcal-1 dietary fibre) for two 2-week periods, with a diet glycaemic index of 60 during one period and 87 during the other. On the low glycaemic index diet, the blood glucose response after a representative breakfast was 29% less than on the high glycaemic index diet (874 +/- 108 (+/- SE) vs 204 +/- 112 mmol min l-1; p less than 0.001), the percentage reduction being almost identical to the 28% difference predicted from the meal glycaemic index values. After the 2-week low glycaemic index diet, fasting serum fructosamine and cholesterol levels were significantly less than after the high glycaemic index diet (3.17 +/- 0.12 vs 3.28 +/- 0.16 mmol l-1, p less than 0.05, and 5.5 +/- 0.4 vs 5.9 +/- 0.5 mmol l-1, p less than 0.02, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)