Electron beam computed tomography screening of the coronary arteries: experience with 3,263 patients at Walter Reed Army Medical Center.

The U.S. Department of Defense desires to reduce the impact of coronary atherosclerosis on its active duty, retired, and dependent populations. Electron beam computed tomography (EBCT) is currently the best way to noninvasively image the coronary arteries directly. Between August 1997 and February 1999, a total of 3,263 patients were scanned by EBCT in the Radiology Department at Walter Reed Army Medical Center. Scans were performed on 2,415 men (74%) and 848 women (26%). The most common age group was 50 to 54 years (25%). Coronary calcification was found in approximately half of the patients (46%), and the magnitude of the score was strongly associated with age and male gender. Average scores increased exponentially with age, doubling every 7 years. In men, average scores ranged from 17 units in those aged 35 to 39 years to 842 in those older than 70 years old. In women, average scores ranged from 1 in those 35 to 39 years to 162 in those older than 70 years. Significant numbers of patients fell into the high-risk categories, with 8% of men in their 40s, 20% of men in their 50s, 33% of men in their 60s, and 49% of men in their 70s with high scores. Scores of more than 400 units were seen in 368 patients (8%) overall. There is a large amount of coronary calcium present in military personnel and their dependents, in patterns that are consistent with previous studies. Many patients had very high scores that are consistent with advanced coronary artery disease. EBCT should play a central role in the identification of occult calcific atherosclerosis of the coronary arteries in military, retired, and dependent patients.

Effects of hybrid and ensiling with and without a microbial inoculant on the nutritional characteristics of whole-plant corn.

Two corn hybrids (Pioneer 3377 and 3389) with similar total plant and grain yield characteristics were evaluated to determine potential differences in nutritive value of the whole plant and stover. Hybrids were grown in plots at four different locations in Idaho in 1988 and 1989 for laboratory evaluation. Samples from the plots were stored fresh or ensiled with or without a microbial inoculant for 60 d in laboratory silos. Whole-plant samples of 3377 had a lower (P < .01) percentage of NDF (42.7 vs 48.1), ADF (26.3 vs 30), hemicellulose (16.2 vs 18.2), cellulose (21.4 vs 24), and lignin (3.4 vs 3.8). Similar differences, but of larger magnitude, were observed in stover samples. Ruminal in situ (24 h) and two-stage IVDMD of whole-plant and stover samples were greater (P < .01) for 3377 than for 3389. Lower fiber content and greater degradability for 3377 was not due to greater grain content; 3377 actually had numerically lower grain as a percentage of whole plant than 3389 (41 vs 44). Ensiling reduced (P < .05) NDF, hemicellulose, and cellulose content compared with fresh samples; however, no effect (P > .10) due to inoculant was noted. Hybrid x storage interactions were not observed (P > .10). Inoculation and hybrid did not affect (P > .10) organic acid concentration of the silages. In 1989 silages from 3377 and 3389 were harvested to evaluate diets containing 65% (DM basis) corn silage in steer digestion and growth trials.(ABSTRACT TRUNCATED AT 250 WORDS)

Hematologic effects and feeding performance in cattle fed cull domestic onions (Allium cepa).

For 119 days, 36 cattle, allotted to 6 treatment groups, were fed a balanced growth diet containing 0, 5, 10, 15, 20, or 25% cull onions on a dry-matter basis. Cattle performance was comparable to that associated with barley-base non-onion diet; statistical differences were not observed among treatments. During the first 28 days of the study, reduction in numbers of RBC, hemoglobin concentration, and PCV was observed in all cattle fed onions, but clinical anemia was not seen in any individual animal. After onion feeding was discontinued at 119 days, RBC numbers, hemoglobin concentration, and PCV returned to baseline values within 30 days. Heinz bodies were detected in erythrocytes of all cattle fed onions, and the percentage was proportional to the amount of onions consumed. Addictive onion consumption was prevented by mixing chopped or crushed onions in a total balanced ration.

Efficacy of vaginal spaying and anabolic implants on growth and carcass characteristics in beef heifers.

Ninety crossbred beef heifers averaging 260 kg were blocked by weight and allotted randomly to 15 pens of six heifers each, with three replicates per treatment. The treatments were spayed heifers (S); intact heifers (I); S + Synovex-H7 (SH); I + Synovex-H (IH); and S + Synovex-S7 (SS). The heifers were spayed vaginally with a Willis instrument; intact heifers were rectally palpated for reproductive soundness. Heifers were fed a growing diet (55 d), re-implanted and subsequently fed a finishing ration (73 or 101 d). All heifers were observed for estrus daily at approximately 0600 and 2000 until d 69. A jugular vein blood sample was obtained from each heifer on d 48, 55, 62 and 69 for blood progesterone analysis. Results of blood progesterone analysis and reproductive tract examination indicated that two spayed heifers were incompletely spayed, a 96% success rate. The SH and SS heifers continued to exhibit estrous behavior despite being successfully spayed. Heifers implanted with Synovex-H had greater (P less than .01) ADG and were more efficient (P less than .03) than nonimplanted heifers. The SS heifers had greater ADG (P less than .05) during the finishing phase than SH heifers, but no advantage of SS over SH was apparent during the growing phase. The overall ADG response to implantation was fourfold greater (P less than .07) in the spayed heifers than in the intact heifers (32 vs 8%). Heifers implanted with Synovex-H had greater adjusted hot carcass weight (P less than .02) and ribeye area (P less than .002) than nonimplanted heifers. For adjusted live weight and ribeye area, the response to implantation was approximately threefold greater in the spayed heifer than the intact heifer. These results demonstrate that spaying and implanting heifers can increase rates and efficiency of gain even though behavioral estrus is not eliminated.

Synovial proliferative disorders: differential diagnosis.

The proper treatment of synovial proliferative disorders depends on an accurate diagnosis and a knowledge of the natural history of these afflictions. A simple classification of the major synovial disorders with a brief general description of each, highlighting the prominent clinical features, is helpful. A thorough history and physical examination should enable the clinician to categorize the nature of the synovial disorder. Further evaluation and consultation can then be directed within the appropriate category. Radiologic, laboratory, and microscopic studies aid in arriving at a definitive diagnosis. Once a diagnosis has been established, therapy or further evaluation can be instituted.

Azathioprine with prednisone for polymyositis. A controlled, clinical trial.

A controlled, prospective, double-blind, therapeutic trial of azathioprine was conducted in the initial therapy of polymyositis. Sixteen patients received 60 mg prednisone per day plus either azathioprine (2 mg/kg of body weight per day) or placebo for a period of 3 months. Creatine phosphokinase (CPK) levels fell to normal slightly sooner in the placebo group, but not significantly so. The azathioprine group did not become significantly stronger (P = 0.58) and did not manifest significantly greater improvement of histopathologic features of muscle (P = 0.80) than the placebo group. Initial CPK elevations were significantly related to the degree of muscle inflammation (P = 0.037), but this was not the case at 3 months (P greater than 0.05). Normalization of the CPK could not be equated with disease control. Type II fiber atrophy, attributed to steroid therapy, was more marked in women than in men (P less than 0.03).

Left atrial myxoma simulating peripheral vasculitis.

Left atrial myxoma remains a diagnostic challenge clinically. A brief review of previously reported cases and their individualistic clinical and laboratory features are described. The present case report documents an unusual clinical presentation, initially directing attention to the central nervous system as well as to the peripheral arterial system. Histologic evidence of peripheral arterial myxomatous emboli, associated with vasculitis but without other confirmatory immunologic evidence of collagen vascular disease, had predated for 14 months the subsequent echocardiographic diagnosis of left artrial myxoma. These findings further emphasize the importance of recognizing the enigmatic and variable clinical presentation of left atrial myxoma.

Polycentric total knee arthroplasty. A two-year follow-up study.

Polycentric total knee arthroplasty provided significant relief of pain in 86 per cent of 500 knees. The independence and activity levels of the patients increased dramatically. The frequency of major complications as reflected by reoperation was 10 per cent in this series. There was a 2.8 per cent deep infection rate. One-third of the infected knees were salvaged and two-thirds required arthrodesis. Loosening of a component was noted in 2.4 per cent. After operation the average range of motion was from 6 to 101 degrees of flexion, for a range of 95 degrees; this was a 5-degree increase over average preoperative motion. Ninety-six per cent of the patients expressed satisfaction with the surgical result.

A statistical evaluation of polycentric total knee arthroplasties.

Four hundred nineteen knees in 299 patients were examined preoperatively and at two years after polycentric total knee surgery. One hundred forty-three knees were in 109 patients with osteoarthritis. Two hundred seventy-six knees were in 190 patients with rheumatoid arthritis. Pain decreased significantly, use of aids decreased significantly, and distance walked increased significantly in both groups. Rheumatoid patients did not fare as well as osteoarthritics in the use of aids and distance walked. Osteoarthritic knees had proportionately more implant settling, implant loosening and reoperations than did rheumatoid arthritic knees.