[Cortisol concentrations in sheep before, during and after sham foot trimming on a tilt table - the suitability of different matrices]. / Kortisolkonzentrationen bei Schafen vor, während und nach der simulierten Klauenbehandlung im Kippstand ­ Eignung verschiedener Matrices.

INTRODUCTION: Matrices that can be collected non-invasively for quantification of a stress response in sheep have received little attention in the veterinary literature. This study examines the suitability of blood, tears and saliva for determining a stress response in sheep undergoing sham foot trimming on a tilt table. The cortisol concentration of blood, tears and saliva and the concentration of cortisol metabolites in faeces were measured in 13 healthy Meat Merino ewes once a day for six days. Sham foot trimming on a tilt table was used as the stressor and was done during a one-hour period on day 4; cortisol concentrations of blood and tears were measured at 0, 10, 20, 30, 40 and 60 minutes. Cortisol concentrations of blood (maximum at 30 minutes) and tears (maximum at 40 minutes) increased during the procedure and then decreased. There were significant correlations between cortisol concentrations of blood and tears (p = 0,04) during sham foot trimming (area under the curve, 0 to 60 minutes). Over the entire 6-day study period, significant correlations were seen between the cortisol concentrations of blood and tears (r = 0,55; p.

INTRODUCTION: Les marqueurs qui peuvent être collectés de manière non invasive pour quantifier une réponse au stress chez le mouton ont fait l'objet de peu d'attention dans la littérature vétérinaire. Cette étude examine la pertinence du sang, des larmes et de la salive pour déterminer une réponse au stress chez des moutons subissant un parage fictif des pieds sur une table basculante. La concentration de cortisol dans le sang, les larmes et la salive ainsi que la concentration de métabolites de cortisol dans les fèces ont été mesurées chez 13 brebis Meat Merino saines une fois par jour pendant six jours. Le parage fictif des pieds sur une table inclinable a été utilisé comme facteur de stress et a été effectué pendant une période d'une heure le jour 4; les concentrations de cortisol dans le sang et les larmes ont été mesurées à 0, 10, 20, 30, 40 et 60 minutes. Les concentrations de cortisol dans le sang (maximum à 30 minutes) et les larmes (maximum à 40 minutes) ont augmenté au cours de la procédure puis ont diminué. Il y avait des corrélations significatives entre les concentrations de cortisol dans le sang et les larmes (p = 0,04) lors du parage fictif des onglons (aire sous la courbe, 0 à 60 minutes). Sur l'ensemble de la période d'étude de 6 jours, des corrélations significatives ont été observées entre les concentrations de cortisol dans le sang et les larmes (r = 0,55 ; p < 0,001), le sang et la salive (r = 0,53 ; p < 0,001) et les larmes et la salive (r = 0,78 ; p < 0,001). La concentration fécale de métabolites de cortisol était significativement augmentée au jour 5 (p 0,05), mais la concentration de cortisol des autres supports n'a pas changé de manière significative au cours de la période d'étude de 6 jours. Le parage fictif des pieds sur une table basculante a été considéré comme un facteur de stress aigu chez les moutons en raison de l'augmentation des concentrations de cortisol dans le sang, des larmes et de l'augmentation des concentrations de métabolites de cortisol dans les selles. La concentration de cortisol dans les larmes était similaire à celle du sang et, par conséquent, la collecte de larmes représente une alternative viable et non invasive au sang pour les tests de cortisol. Le délai des pics entre la concentration maximale de cortisol dans les larmes et le sang doit être pris en compte lors de l'interprétation des résultats.

[An important differential diagnosis for persistent back pain]. / Infektiöse Spondylitis als Differenzialdiagnose persistierender Rückenschmerzen. Atiogenese, Diagnostik und Therapie Vertebral osteomyelitis.

PATIENTS: Between 1/1994 and 12/1998 40 patients with a vertebral osteomyelitis were treated at the Orthopedic University Hospital of Witten/Herdecke. All data of 15 female and 25 male patients with an mean age of 61 years (25-87 years) were analyzed in a retrospective study. Diagnosis of vertebral osteomyelitis was made between 1 and 84 weeks after onset of symptoms. Before admissions in our hospital up to 4 hospitalizations without proper diagnosis were reported. TREATMENT: The treatment consisted bed-rest in an individual orthesis and percutaneous discovertebral biopsy before systemic administration of antibiotics. In 11 from a total of 21 biopsies we could prove bacteria as follows: 6 times Staphylococcus aureus, 2 times E. coli and 3 times Mycobacterium tuberculosis. Radiological diagnosis was made by conventional x-ray in 2 dimensions and nuclear magnetic resonance. Together with radiological, histological, microbiological and laboratory investigation we found 11 patients with a specific tuberculosis of the spine, 25 patients with a pyogenic vertebral osteomyelitis and 4 patients with a post-nucleotomy osteomyelitis. 14 patients underwent operative treatment. All patients were mobilized in an individual brace after CRP and ESR indicated remission of inflammation. DURATION OF HOSPITAL TREATMENT: Duration of the hospital treatment lasted between 33 and 137 days. At follow-up 12 months after demission 35 patients were free of symptoms, two patients had still signs of osteomyelitis, two patients, one of them with recurrence of spondylitis, were reoperated because of dislocation of the implants, and one patient died after surgery suffering from severe peritonitis and multi-organ-failure. DISCUSSION: We report pathogenesis and the current diagnostic and therapeutic concept of treatment of the vertebral osteomyelitis. Despite modern diagnostic possibilities, diagnosis of vertebral osteomyelitis is often made very late. Vertebral osteomyelitis is an important differential diagnosis for persistent back pain and needs to be considered more often.

[Long-term experiences with mechanical patient-controlled analgesia pumps for therapy of postoperative pain in general surgery]. / Langzeiterfahrungen in der Anwendung mechanischer PCA-Pumpen zur Therapie postoperativer Schmerzen in der Allgemeinchirurgie.

The efficiency and safety of patient-controlled analgesia (PCA) in the treatment of postoperative pain is well documented. An alternative to electrical systems is the disposable pump, which is cost effective. The aim of this study was to prove the efficiency and safety of PCA disposable pumps. Eighty patients (45 men, 35 women, mean age 50 +/- 16 years) were included and received single-use PCA pumps (Vygon Medical Products, Aachen, Germany) for postoperative pain control. A sufficient reduction in pain levels, measured by the Verbal Rating scale (VRS), was achieved in nearly all patients. For the first application, a single bolus of 7.0 +/- 2 mg piritramide (Dipidolor) was needed, the mean of treatment time was 56 +/- 31 h. We had two dropouts because of non-compliance, two patients felt dizzy, and one patient felt nauseous. Further side-effects were observed during treatment. Our study led us concluded that PCA therapy with mechanical, disposable pumps is a safe and efficient treatment for postoperative pain. Such a concept can be introduced without an "Acute Pain Service" if the staff are well trained.

[Inflammatory pseudotumor of the spleen as an incidental asymptomatic finding in a 44-year-old patient]. / Inflammatorischer Pseudotumor der Milz als akzidenteller asymptomatischer Befund bei einer 44jährigen Patientin.

In the era of routinely used ultrasound techniques intrasplenic tumors are diagnosed more frequently. Usually these findings are not combined with specific symptoms. However, large cysts can lead to malfunctions of nearly located organs by displacing. Etiopathogenetic findings in our region are mainly non parasitic, epithelial and traumatic cysts or tumors of the spleen. We describe a large splenic mass of a 44 years old female patient. Pathological dignity remained unclear after using sonographic, radiological and clinical techniques. After uncomplicated total splenectomy the histopathological diagnosis revealed a benign, pseudoinflammatory tumor of the spleen. Inflammatory pseudotumors are a benign response to an unknown cause. It must be a main objective of preoperative diagnostics to distinguish them from malignant processes.

[Peri- and postoperative pain therapy with mechanical patient-controlled disposable analgesia pumps in general surgery. Report of initial trial]. / Peri- und postoperative Schmerztherapie mit mechanischen PCA-Einmal-Pumpen in der Allgemeinchirurgie. Ein erster Anwendungsbericht.

The patient-controlled analgesia (PCA) or "ondemand analgesia" is a pain-relieving therapy, which is regulated and monitored by the patient himself. Postoperative pain therapy is the main approach for PCA, which facilitates a long-term, individually controlled pain relief. In certain situations we use mechanical PCA-pumps filled with piritramid (Dipidolor) as an opioid-analgetic for reducing postoperative pain. This kind of therapy needs the acceptance and understanding of the patient as a main condition for the success. Beside an increase of patients' comfort and patients' independence of analgetic demand from the medical staff a reduction in postoperative complications can be expected, the time of hospitalisation might be decreased.

3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitor simvastatin and the human lens. Clinical results of a 3-year follow-up.

Simavastatin (MK-733, Zocor, CAS 79902-63-9), a new 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, was administered for a period of at least 3 years to 21 patients suffering from primary hypercholesterolemia. Significant decreases were noted for plasma cholesterol (30%), low density lipoprotein cholesterol (40%), whereas an increase in plasma high density lipoprotein cholesterol (11%) was observed. The drug therapy was well tolerated and clinical examinations revealed no adverse effects. No development of cataracts or other ocular side effects have been observed during this 3-year follow-up period.

Serum Lp(a) concentrations are unaffected by treatment with the HMG-CoA reductase inhibitor Pravastatin: results of a 2-year investigation.

The concentration of lipoprotein (a) in plasma is under stringent genetic control and raised concentrations are strongly linked to coronary heart disease, in particular when low density lipoprotein levels are also increased. We serially monitored serum Lp(a) in 14 hypercholesterolemic patients who were treated with Pravastatin over a period of two years. C-reactive protein levels were also quantified to exclude a possible 'acute-phase' response as a reason for a sudden increase in the Lp(a) concentration. No significant changes were seen in mean Lp(a) levels after 24 months of therapy. Considerable fluctuations of serum Lp(a) levels occurred during the course of treatment. These were in some cases associated with raised C-reactive protein concentrations and might therefore be attributable to an 'acute-phase' response. We conclude that the HMG-CoA reductase inhibitor Pravastatin has no long-lasting effects on Lp(a) levels in hypercholesterolemic patients suffering from coronary heart disease.

Pravastatin--ocular side effects after a two year follow-up?

Pravastatin, a new HMG-CoA-reductase inhibitor, was administered to hypercholesterolemic 14 patients with coronary heart disease for a period of two years. This drug reduces the plasma LDL-cholesterol concentrations approximately 30-40%. No development of cataracts or other ocular side effects could be observed during this two year follow-up.