Use of positive contrast rhinography and intranasal sinography for diagnosis of a nasofacial sinus tract in a dog.

Twelve days after a dog fight, a 2-year-old sexually intact female Bulldog was evaluated because of subcutaneous emphysema of increasing severity throughout the dogs body. Thoracic radiography revealed severe pneumomediastinum from which free air had extended into the retroperitoneal space, resulting in pneumoperitoneum. Tracheoscopic examination did not reveal a discontinuity of the trachea, pharynx, or larynx. A breach between the nasal cavity and subcutaneous tissues of the nasal region was suspected. Further diagnostic investigations included positive contrast rhinography and intranasal sinography. Via an angiographic catheter inserted into the left naris, positive contrast intranasal sinography revealed a sinus tract extending between the left nasal cavity and the subcutaneous tissue of the dorsal aspect of the nasal planum. Resolution of subcutaneous emphysema, pneumomediastinum, and pneumoretroperitoneum began 1 day after surgical closure of the intranasal opening of the sinus tract. To the authors' knowledge, this radiographic technique has not been reported.

Quality improvement efforts in prenatal care for Oklahoma Medicaid managed care patients: 1995-1998.

The Oklahoma Health Care Authority and the Oklahoma Foundation for Medical Quality analyzed documented patterns of care in the Oklahoma Medicaid urban managed care plans from 1995 through 1998. In 1995, 31.3% of the patients had started prenatal care in the first trimester, and 50.6% of the patients had first trimester prenatal care in 1998. No prenatal care was noted for 3.2% in 1995, which decreased to 2.9% for 1998. For 1995, 23.9% of the deliveries were operative and 20.8% for 1998. Similarly, the vaginal delivery after previous C-section (VBAC) rate was 36.5% for 1995, and increased to 41.0% in 1998. Very low birth weight (defined as below 1500 grams) rates were 3.7% for 1995 and 1.3% for 1998, while the low birth weight (between 1500 and 2499 grams) infants were recorded for 7.8% of the live births in 1995, and for 1998, 7.5%. While there has been improvement in rates over the four years of the study, opportunities for improvement in the provision of the prenatal care for the Oklahoma Medicaid managed care population remain.