Fresh fields and pathways new: recent genetic insights into cardiac malformation.

Cardiovascular malformations are the most common type of birth defect. Currently, only a fraction of cases have associated causative factors and little is known about the aetiology of the rest. Despite this, our understanding of normal and abnormal heart development continues to grow, a number of recent discoveries even challenging long-held concepts. In this review, we highlight some of this new knowledge, emphasising aspects that may be of interest to the clinician.

Unoperated tetralogy of Fallot: case report of a natural survivor who died in his 73rd year; is it ever too late to operate?

The case history is described of a man in his 73rd year who was one of the oldest surviving patients with uncorrected tetralogy of Fallot (ToF) before succumbing with renal failure. Factors contributing to his longevity included small pulmonary arteries and presumed slow development of subpulmonary obstruction together with moderate concentric left ventricular hypertrophy--features previously seen in long term survivors. Less than 3% of all patients with uncorrected ToF survive beyond their 40s but late operative repair is still a valuable option. Practicalities of renal dialysis in the presence of an intracardiac shunt are considered.

The relationship between adult happiness and self-appraised childhood happiness and events.

The primary purpose of the present research was to relate questionnaire-assessed self-reported childhood happiness and events to adulthood happiness in 387 non-clinical participants. Although childhood happiness and adult happiness were found to be significantly correlated (r = .28, p < .001), there was little relationship between reported adult happiness and reported specific childhood events and circumstances. Childhood events and circumstances, however, were much more highly correlated with childhood happiness (R = .64). Thirty-four percent of the persons who said they were unhappy or very unhappy as a child, but only 9% who said they were happy or very happy as a child, reported that they were unhappy or very unhappy as adults.

Laparoscopic colopexy in horses.

OBJECTIVE: To describe a technique for laparoscopic colopexy in horses. STUDY DESIGN: Description of a technique to perform laparoscopic colopexy in horses. ANIMALS: Six healthy adult horses between 3 and 23 years of age and weighing between 440 and 636 kg. METHODS: Horses were positioned in dorsal recumbency, and the abdomen was insufflated to an intraabdominal pressure of 15 mm Hg. A laparoscope portal was placed at the umbilicus, and instrument portals were placed cranial to the laparoscope and lateral to midline. The lateral taenia of the left ventral colon was laparoscopically identified and retracted with Babcock forceps to the peritoneal surface and sutured with two strands of size 2 monofilament nylon in a continuous pattern via laparoscopic observation. All horses were euthanatized 90 days after surgery, and the colopexy adhesion was examined histologically. RESULTS: Laparoscopic colopexy was successful in all six horses. There were no intraoperative or postoperative complications. Initial abdominal insufflation to 15 mm Hg required an average of 38 L (range 32 to 46 L) of carbon dioxide and 9.8 minutes (range 9 to 11 minutes) to be completed. A total of 132 L of carbon dioxide (range 64 to 196 L) was needed for the entire procedure. The laparoscopic colopexy procedure required 95 minutes (range 60 to 142 minutes) to perform. Laparoscopic colopexy resulted in a firm, fibrous adhesion of the colon to the abdominal tunic. Microscopically the colopexy adhesion was mature fibrous tissue with no evidence of inflammation. CONCLUSIONS: Laparoscopic colopexy can be successfully performed in horses with minimal abdominal invasion.

Endoscopic ovariohysterectomy in two lions (Panthera leo).

Endoscopic techniques were used to ovariohysterectomize two hybrid Asian lions (Panthera leo) in order to reduce the risk of postoperative wound complications associated with standard surgical techniques. One of the lions was aged, overweight, and considered an anesthetic risk. The animals were anesthetized, intubated, catheterized intravenously, and placed in dorsal recumbency with the head lower (Trendelenburg position). Ventilation was assisted mechanically. Following abdominal insufflation, a surgical trocar was placed in the abdominal cavity. Two additional 12-mm surgical trocars were placed under direct visualization using a videoscope. The ovaries and uterus were removed endoscopically, and the abdominal cavity was inspected for hemorrhage under decreased insufflation pressure before closure. The surgery was complicated by obesity, by uterine enlargement from cystic endometrial hyperplasia and endometrial polyps, and by ovarian enlargement and fragility because of bilateral cystic rete ovarii. The procedure and anesthetic recovery were uneventful. Postsurgical recovery time and convalescence lasted less than 3 days, and the animals were reintroduced to an exhibit mate and placed on exhibit within 8 days. The technique is appropriate for use in lions, even those with pathologic reproductive changes, in zoos.

Congenital skin diseases.

The purpose of this chapter is to review some of the common congenital and hereditary skin diseases in domestic animals. Alopecia, abnormalities in pigmentation, and structural defects of the dermis are addressed in a problem-solving format. Features of other miscellaneous congenital and hereditary skin diseases are discussed. Specific breed and species involvement and the ages of onset are identified. Modes of inheritance and information on recognizing patterns of inheritance by pedigree analysis are presented. Clinical and pathologic findings important to differential diagnosis of these conditions are summarized. Advanced diagnostic techniques useful in further characterizing these conditions are presented.

The automatic implantable cardioverter/defibrillator for a life threatening arrhythmia in a case of post-partum cardiomyopathy.

We report the development of severe life threatening polymorphic ventricular tachycardia in a young woman shortly following her first pregnancy, who ultimately required the insertion of an automatic implantable cardioverter/defibrillator because of the failure of conventional antiarrhythmic therapy. Although only about 7 patients have received units in the UK to date, the experience in the USA, where up to 300 per month may be implanted, suggests that they will become a more common method of treatment in cases of life threatening arrhythmias.

Biomechanical properties of skin and wounds in Ehlers-Danlos syndrome.

The biomechanical properties of wounded and nonwounded skin were studied in three dogs and three cats affected with type I Ehlers-Danlos syndrome. Three nonaffected dogs and one nonaffected cat served as controls. Samples of wounded skin and adjacent normal skin were harvested at days 75, 138, 141, 144, 147, and 150. Samples were subjected to uniaxial tensile strength testing. Tensile strength, energy absorbed, and site of failure were recorded. In the dogs with Ehlers-Danlos syndrome, there was an increase in tensile strength in samples containing a scar over adjacent intact skin. In nonaffected dogs, affected cats and the nonaffected cat, the nonwounded skin samples had greater tensile strength. The energy absorbed by the skin samples during testing was highly correlated with tensile strength.

Cutaneous wound healing in Ehlers-Danlos syndrome.

Wound healing in five dogs and five cats affected with a connective tissue dysplasia resembling Ehlers-Danlos syndrome of humans was compared with wound healing in 10 nonaffected animals. Six skin incisions on the lateral aspects of the thorax and abdomen of each animal were sutured and assessed daily for 75 days for evidence of healing. All wounds in nonaffected dogs, affected cats, and nonaffected cats healed by first intention. Three incisions in affected dogs had dehiscence of all or part of the incision line and healed by granulation, contraction, and epithelialization. Biopsies taken at 3, 6, 9, 12, 15, and 75 days were compared histologically to determine if there were any differences in rates of healing between affected and nonaffected animals. Epidermal thickening and scab formation were noted at days 3 and 6 in both affected and nonaffected animals. Infiltration with mononuclear cells and fibroplasia steadily increased from day 6 to day 15 in all groups. Collagen fibril formation was evident by day 9. At day 75, incision sites were recognized by fine, more compact collagen bundles and lack of adnexal structures, as compared with the adjacent dermis in both affected and nonaffected animals. Although delayed wound healing has been reported to be a complication of Ehlers-Danlos syndrome in humans, using clinical and histologic criteria, wound healing in dogs and cats with Ehlers-Danlos syndrome appears to be similar to nonaffected animals.

The 'think test': a further technique to elicit hyperventilation.

Hyperventilation can undermine cardiovascular homeostasis by generating autonomic imbalance, sympathetic dominance, hypokalaemia, and intracellular alkalosis with calcium ion shifts. The role of hyperventilation in episodic disorders such as arrhythmia and coronary vasospasm can be difficult to identify if the patient does not present in an attack and so a provocation challenge is required. Today, the standard challenge is the forced hyperventilation provocation test (FHPT). A capnograph enables the resting end-tidal PCO2 to be compared with the level 3 min after the period of overbreathing. We report the use of a patient-specific challenge. After the FHPT, the subject is invited to close his eyes and think about the circumstances of an attack, feelings and sensations experienced (breathing is not mentioned) or topics that were seen to disturb the rhythm of breathing when the medical history was taken. A fall of end-tidal PCO2 of 10 mmHg or more lasting at least one minute was taken as a positive response. Out of 57 patients with cardiovascular symptoms suggesting a hypocapnic influence, resting hypocapnia (end-tidal PCO2 = 30 mmHg) was present in 3 (5%). Of the remaining 54, the FHPT was positive in 16 (30%) and the 'think test' in 33 (61%). This suggests that patient-specific stimulation has advantages over an unspecific challenge in testing for episodic hypocapnia.

The effect of the type A behaviour pattern on myocardial ischaemia during daily life.

Twenty-eight subjects completed 2 Type A questionnaires. Just under half the patients were considered Type A. Painful episodes of myocardial ischaemia occurred more frequently in Type A patients during a stressful period of ambulatory Holter monitoring compared to a later date. This difference could not be explained in terms of severity of disease or length of myocardial ischaemia. Rather it seemed to reflect increased reporting of somatic symptoms on the background of a greater sensitivity to environmental stress. Type A patients may thus present themselves earlier than their Type B peers.