Accompanied consultations in occupational health.

BACKGROUND: Accompanied consultations are often reported as difficult by occupational physicians but have not been studied in the occupational health setting. AIMS: To collect information about accompanied consultations and the impact of the companion on the consultation. METHODS: We collected data on all accompanied consultations by two occupational physicians working in a private sector occupational health service over the course of 16 months. Accompanied consultations were matched to non-accompanied consultations for comparison. RESULTS: We collected data on 108 accompanied consultations. Accompanied consultations were more likely to be connected with ill health retirement (P < 0.01), have a neurological diagnosis or multiple diagnoses (P < 0.01), be rated as complex (P < 0.01) and take longer than 30 minutes (P < 0.01) than non-accompanied consultations. Over half of the companions (54%) were a spouse or partner. An impact by the companion was recorded in 81% of consultations but this was most frequently that they had provided information (56%) and in over a quarter the impact was recorded as helpful. Interruptions were recorded in 28% of accompanied consultations but only 6% of consultations had free text suggesting that the consultation or companion was difficult. CONCLUSIONS: Accompanied consultations are likely to be more challenging in terms of the reason for referral, the presenting medical problems, the complexity of the case and the duration of the consultation. However, the companion is more likely to be of benefit than cause difficulty. Occupational health practitioners may benefit from better understanding of accompanied consultations and guidance on their management.

An intrapericardial technique for PDA ligation: surgical description and clinical outcome in 35 dogs.

A number of surgical techniques have been reported for dissection and ligation of patent ductus arteriosi (PDAs) in dogs. The objectives of this study were to provide a detailed description of an intrapericardial technique for PDA dissection and ligation and to report the clinical outcome of that technique in dogs. Medical records of 35 dogs were retrospectively reviewed for signalment, clinical signs, echocardiographic findings, surgical time, intra- and postoperative complications, and completeness of ductal closure. Median surgery time was 60 min (range, 35-125 min). Neither intraoperative nor postoperative complications occurred. Within 48 hr of surgery, the continuous left basilar heart murmur was absent in all dogs, and complete echocardiographic closure was confirmed in 29 of 32 dogs. Residual flow was identified echocardiographically in three dogs within 48 hr of surgery. Residual flow was decreased in one dog at 1 mo, which resolved within 33 mo. One dog had mild residual flow postoperatively but did not return for follow-up. The intrapericardial technique was successful for PDA dissection and ligation and had a lower rate (6%) of echocardiographic residual flow compared with previously reported techniques.

Gastroesophageal intussusception in a leopard (Panthera pardus).

An 8-yr-old male leopard (Panthera pardus) was presented with a 4-day history of lethargy, vomiting, and anorexia. Thoracic and abdominal radiographs revealed a soft-tissue mass cranial to the diaphragm and atypical appearance of the gastric fundus. Esophagoscopy revealed gastric mucosa in the lumen of the esophagus, which confirmed gastroesophageal intussusception. An exploratory celiotomy with manual reduction of the intussusception was performed. Reduction was verified by intraoperative esophagoscopy and gastroscopy. An incisional fundic gastropexy to the left abdominal wall was performed to reduce the chance of a recurrence of the intussusception. No postoperative complications related to the surgery were observed, and the animal resumed eating within 48 hr of surgery. A subsequent recurrence of clinical signs was not noted by the owner.

Esophageal hiatal hernia in three exotic felines--Lynx lynx, Puma concolore, Panthera leo.

Hiatal hernia was diagnosed in three exotic felines-lynx (Lynx lynx), cougar (Puma concolore), and lion (Panthera leo). All cats had a history of anorexia. Thoracic and abdominal radiographs showed evidence of a soft tissue mass within the caudal mediastinum suggestive of a hiatal hernia in all animals. A barium esophagram was performed in one case. All animals underwent thoracic or abdominal surgery for hernia reduction. Surgical procedures included: intercostal thoracotomy with herniorrhaphy and esophagopexy (lynx and cougar), and incisional gastropexy (lion). Concurrent surgical procedures performed were gastrotomy for gastric foreign body removal and jejunostomy tube placement. Clinical signs related to the hiatal hernia disappeared after surgery and recurrence of signs was not reported for the time of follow-up.

Outcome of permanent tracheostomy for treatment of upper airway obstruction in cats: 21 cases (1990-2007).

OBJECTIVE: To determine clinical outcome of permanent tracheostomy in cats with upper airway obstruction. DESIGN: Retrospective case series. ANIMALS: 21 cats. PROCEDURES: Medical records were reviewed for information on history, signalment, clinical signs, results of preoperative clinicopathologic testing, cause of upper airway obstruction, surgical procedure, postoperative complications, and outcome. RESULTS: Causes of upper airway obstruction included neoplasia (squamous cell carcinoma [n = 6] or malignant lymphoma [2]), inflammatory laryngeal disease (5), laryngeal paralysis (4), trauma (3), and a laryngeal mass of unknown cause (1). Fourteen cats had dyspnea in the immediate postoperative period; dyspnea most often resulted from mucous plugs at the stoma or elsewhere in the respiratory tract. Eleven cats died, including 6 cats that died while hospitalized after surgery and 5 cats that died after discharge; 7 cats were euthanatized, most often because of progression of neoplasia; and 2 were still alive at the time of the study. The remaining cat was lost to follow-up after discharge from the hospital. Overall, median survival time for the 20 cats for which information was available was 20.5 days (range, 1 day to 5 years). Cats that underwent permanent tracheostomy because of inflammatory laryngeal disease were 6.61 times as likely to die as cats that underwent permanent tracheostomy for any other reason. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that permanent tracheostomy was an uncommon procedure in cats with upper airway obstruction that was associated with high complication and mortality rates.

Sudden, unexpected cardiac or unexplained death in England: a national survey.

BACKGROUND: Post-mortem examinations of adults who were apparently healthy but died suddenly and unexpectedly sometimes reveal no morphological abnormalities to explain their deaths. The frequency of such unexplained deaths in relation to other causes of sudden cardiac death is not known. AIM: To estimate the frequency of sudden unexpected cardiac or unexplained death in England. DESIGN: Prospective survey using a stratified random sample of 83 of the 132 H.M. Coroner's jurisdictions in England. METHODS: Consecutive White Caucasians, aged 16-64 years, with no medical history of cardiac disease, seen alive within 12 h of death, on whom autopsy found either a cardiac or no identifiable cause of death, were included. The coroner's officer sent a copy of the post-mortem report and a completed case registration form to the investigators, with tissue samples. RESULTS: Sixty-seven (81%) coroners participated, each maintaining prospective surveillance for 4 months. Of 692 ascertained cases, case registration forms were received for 650 (94%), post-mortem reports for 682 (99%), blood samples for 569 (82%), myocardial slices for 517 (75%) and whole hearts for 47 (7%). In cases with myocardial tissue, death was ascribed to ischaemic heart disease in 465 (82.4%). In 43.1% the ischaemia was acute, in 19.1% there was myocardial scarring but no acute ischaemia, and 20.2% had coronary atheroma only. Death was due to left ventricular hypertrophy in 32 (5.7%), to other cardiac causes in 30 (5.3%) and in 23 (4.1%) there was no clear cause. Those with cardiac causes were 81% male, median ages 55.9 (male) and 56.6 (female) years. The 23 unexplained deaths were 57% female, median ages 40.5 (male) and 54.9 (female) years. The estimated annual frequency of sudden unexpected death due to cardiac or unidentified causes, in English adults of employment age, was 11/100,000 (3481 annual deaths). DISCUSSION: In 4.1% of sudden unexpected deaths under 65 years, no cause was found. Until it becomes accepted practice to identify these cases by a name, such as Sudden Adult Death Syndrome (SADS), it will not be possible to study their aetiology systematically.

Long-term outcome of gonadectomy performed at an early age or traditional age in dogs.

OBJECTIVE: To determine long-term results and complications of gonadectomy performed at an early age (prepubertal) or at the traditional age in dogs. DESIGN: Cohort study. ANIMALS: 269 dogs from animal shelters. PROCEDURE: Dogs that underwent gonadectomy were allotted to 2 groups on the basis of estimated age at surgery (traditional age, > or =24 weeks old; prepubertal, < 24 weeks old). Adoptive owner information was obtained from shelter records, and telephone interviews were conducted with owners to determine physical or behavioral problems observed in the dogs since adoption. Follow-up information was obtained from attending veterinarians for dogs with complex problems or when owners were uncertain regarding the exact nature of their dog's problem. RESULTS: Prepubertal gonadectomy did not result in an increased incidence of behavioral problems or problems associated with any body system, compared with traditional-age gonadectomy, during a median follow-up period of 48 months after gonadectomy. Rate of retention in the original adoptive household was the same for dogs that underwent prepubertal gonadectomy as those that underwent traditional-age gonadectomy. Infectious diseases, however, were more common in dogs that underwent prepubertal gonadectomy. CONCLUSIONS AND CLINICAL IMPLICATIONS: With the exception of infectious diseases, prepubertal gonadectomy may be safely performed in dogs without concern for increased incidence of physical or behavioral problems during at least a 4-year period after gonadectomy.

Long-term outcome of gonadectomy performed at an early age or traditional age in cats.

OBJECTIVE: To determine long-term results and complications of gonadectomy performed at an early age (prepubertal) or at the traditional age in cats. DESIGN: Cohort study. ANIMALS: 263 cats from animal shelters. PROCEDURE: Cats that underwent gonadectomy were allotted to 2 groups on the basis of estimated age at surgery (traditional age, > or = 24 weeks old; prepubertal, < 24 weeks old). Adoptive owner information was obtained from shelter records, and telephone interviews were conducted with owners to determine physical or behavioral problems observed in the cats after adoption. Follow-up information was obtained from attending veterinarians for cats with complex problems or when owners were uncertain regarding the exact nature of their cat's problem. RESULTS: Compared with traditional-age gonadectomy, prepubertal gonadectomy did not result in an increased incidence of infectious disease, behavioral problems, or problems associated with any body system during a median follow-up period of 37 months. Additionally, the rate of retention in the original adoptive household was the same for cats that underwent prepubertal gonadectomy as those that underwent traditional-age gonadectomy. CONCLUSIONS AND CLINICAL RELEVANCE: Prepubertal gonadectomy may be performed safely in cats without concern for increased incidence of physical or behavioral problems for at least a 3-year period after gonadectomy.

Endogenous lipid (cholesterol) pneumonia associated with bronchogenic carcinoma in a cat.

An 11-year-old, female domestic longhair was presented for dyspnea, vomiting, and left forelimb lameness. A mass in the left caudal lung lobe was seen on thoracic radiographs. The mass was resected during thoracotomy, and histopathology confirmed a diagnosis of endogenous lipid pneumonia. The cat recovered slowly from surgery and was euthanized 11 days following discharge because of persistent respiratory difficulties. Necropsy findings included lipid pneumonia and bronchogenic carcinoma, with probable tumor metastasis to the small intestine, spleen, kidney, and left triceps muscle.

Treatment of traumatic separation of the auricular and annular cartilages without ablation: results in five dogs.

Five dogs were diagnosed as having unilateral separation of the otic cartilages (auricular and annular). Four dogs had sustained prior trauma (hit by a car). Clinical signs were typical of ear canal stenosis and included swelling at the base of the ear (n = 2), periotic fistulation (n = 2), head tilt toward the affected side (n = 2), and pain when opening the mouth (n = 1). Palpation revealed separation of the horizontal and vertical ear canals. Otoscopic findings included a shallow ear canal and a pseudotympanic membrane across the proximal end of the auricular cartilage. Findings at surgery confirmed the diagnosis of cartilage separation and included an exudate-filled horizontal ear canal and a blind-ending vertical ear canal. Surgical treatment involved isolating the distal end of the annular cartilage (horizontal ear canal), opening and evacuating the horizontal ear canal, and suturing the open end of the annular cartilage to the skin. The length of annular cartilage was variable among the dogs, although each dog had sufficient horizontal canal to appose skin to otic epithelium. The vertical ear canal was not surgically dissected or manipulated. The mean follow-up period was 46 +/- 14 months (range, 31 to 68 months). All five dogs had patent horizontal ear canals when examined at the follow-up examination.

Effects of the 5-HT1A antagonist (+)-WAY-100135 on murine social and agonistic behavior.

Compounds previously identified as 5-HT1A antagonists have subsequently been demonstrated to possess partial agonistic properties in models assessing somatodendritic autoreceptor function. This study examined the influences of (+)-WAY-100135, claimed to be the first selective 5-HT1A antagonist, on offensive behaviour in male mice. Employing a resident-intruder paradigm, administration of (+)-WAY-100135 (1.0-10.0 mg/kg s.c.) enhanced elements of resident offensive behaviour at 2.5 and 5.0 mg/kg but reduced such behaviour at 10.0 mg/kg. In comparison, resident defensive postures remained unchanged except for a significant increase in defensive sideways behaviour at 10.0 mg/kg. These effects were accompanied by reduced rearing behaviour across the dose range tested. Attend/approach behaviour was significantly reduced at the lowest, but increased at the highest, doses tested. Such results may reflect response competition rather than concomitant motor impairment. Given the dynamic behavioural interactions occurring in this paradigm, the increased offensive behaviour of the resident mice leads to enhanced defence and counter-attack by the intruder conspecifics. The results are discussed with reference to the current literature concerning the behavioural effects of other 5-HT1A antagonists.

A British Cardiac Society survey of the potential for the secondary prevention of coronary disease: ASPIRE (Action on Secondary Prevention through Intervention to Reduce Events).

OBJECTIVE: To measure the potential for secondary prevention of coronary disease in the United Kingdom. DESIGN: Cross sectional survey of a representative sample of coronary patients from a retrospective review of hospital medical records and patient interview and examination. SETTING: Stratified random sample of 12 specialist cardiac centres and 12 district general hospitals drawn from 34 specialist cardiac centres and 261 district general hospitals in 12 geographic areas in the United Kingdom. SUBJECTS: 2583 patients < or = 70 yr; 25 consecutive males and 25 consecutive females identified retrospectively in each of four diagnostic categories: coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, acute myocardial infarction, and acute myocardial ischaemia without evidence of infarction. MAIN OUTCOME MEASURES: Risk factor recording and management in medical records; the prevalence and control of risk factors at interview six months after the procedure or event. RESULTS: Recording of coronary risk factors in patient's records was incomplete and this varied by risk factor. Smoking habit and blood pressure were most completely recorded, whereas a history of hyperlipidaemia and blood cholesterol concentrations were least complete. Risk factor records were more likely to be complete in cardiac centres than in district hospitals. At interview 10% to 27% of patients were still smoking cigarettes and 75% remained overweight, females more severely so. Up to a quarter of patients remained hypertensive, males more severely so than females. Over three quarters had a total cholesterol > 5.2 mmol/l. In patients on medication for blood pressure, cholesterol or glucose, risk factor profiles were little better than in those who were not. Only about one patient in three was taking a beta blocker after infarction. Up to a fifth of patients who had had acute myocardial ischaemia were not taking aspirin at follow up. CONCLUSIONS: There is considerable potential to reduce the risk of a further major ischaemic event in patients with established coronary disease. This can be achieved by effective lifestyle intervention, the rigorous management of blood pressure and cholesterol, and the appropriate use of prophylactic drugs.

Surgical treatment of tracheal collapse in dogs: 90 cases (1983-1993).

OBJECTIVE: To determine factors associated with long-term outcome in dogs with tracheal collapse treated with extraluminal polypropylene C-shaped stents. DESIGN: Retrospective case series. ANIMALS: 90 dogs. PROCEDURE: Medical records of dogs with surgically treated tracheal collapse were reviewed. Follow-up was obtained either by recheck at the veterinary teaching hospital only (n = 10) or by telephone interviews with referring veterinarians and owners (n = 35), referring veterinarians alone (n = 23), or owners alone (n = 16). The chi 2 test was used to determine which factors were associated with long-term outcome. RESULTS: 11 breeds were represented. Yorkshire Terriers, Poodles, and Pomeranians were most common. Median age at the time of surgery was 6.8 years. Median weight was 2.9 kg. Severity of collapse ranged from grade II to grade IV. Dogs < 6 years old had more severe collapse than did dogs > or = 6 years old. Dogs > or = years old had more postoperative complications and a poorer longterm outcome than did dogs < 6 years old. 17 dogs required permanent tracheostomy, 10 within 24 hours after surgery. CLINICAL IMPLICATIONS: Surgical placement of extraluminal polypropylene C-shaped stents was an effective method of attenuating clinical signs of tracheal collapse. Dogs < 6 years old had more severe tracheal collapse but did better after surgery than did dogs > or = 6 years old.

5-HT1A receptor influences on rodent social and agonistic behavior: a review and empirical study.

Investigations examining the influence of 5-HT1A receptors in murine agonistic and social behavior have reported either specific or nonspecific attenuation of offensive behavior. To clarify this situation, the effects of three 5-HT1A agonists were examined on isolation-induced aggression and social behavior in male mice. 8-OH-DPAT (0.025-1.25 mg/kg) increased social behavior, rearing, and digging. Offensive behavior was reduced, without concomitant sedation. Ipsapirone (0.1-10.0 mg/kg) reduced naso-nasal behavior, whilst enhancing stretched-attend behavior, cage-exploration, and rearing. Offensive and defensive behaviors were attenuated, without reductions in activity. MDL 73005 EF (0.25-8.0 mg/kg) reduced social behaviors, cage-exploration and rearing while maintenance behavior was increased. Offensive and defensive behaviors showed attenuation. Current results corroborate previous findings with respect to 5-HT1A receptor involvement in murine agonistic behavior and anxiety. Data also connote that the behavioral specificity of 5-HT1A ligands should be interpreted in terms of response competition rather than solely concomitant sedation.

Effects of (-)-pindolol and SDZ 216-525 on social and agonistic behavior in mice.

In view of conflicting results reported for 5-HT1A receptor involvement in murine social conflict, this study examined the effect of two compounds, SDZ 216-525 and (-)-pindolol, on agonistic and social behavior in male mice. In a resident-intruder paradigm, (-)-pindolol (1.0-20.0 mg/kg), a beta-adrenergic 5-HT1A/1B antagonist, significantly attenuated all agonistic behaviors across the dose range employed. Social behaviors showed significant decreases, while nonsocial cage exploration showed significant increases at all doses. Defensive evade was significantly attenuated at 20.0 mg/kg. SDZ 216-525 (0.025-1.0 mg/kg), a selective 5-HT1A antagonist, significantly attenuated offensive posturing and bite-attacks at 1.0 mg/kg, and all offensive behaviors nonsignificantly at the smaller doses tested. Rearing was significantly attenuated at 1.0 mg/kg, while cage exploration increased at this dose. Defensive and social behaviors remained largely unchanged. These results show that both compounds tested produced significant reductions in offensive behavior, with concomitant changes in defensive, social, and nonsocial behaviors. Results are discussed in relation to SDZ 216-525 and (-)-pindolol potential for the control of anxiety and agonistic behavior.

Effects of pindobind 5-hydroxytryptamine1A (5-HT1A), a novel and potent 5-HT1A antagonist, on social and agonistic behaviour in male albino mice.

In view of inconsistent results reported for 5-hydroxytryptamine1A (5-HT1A) receptor involvement in murine social conflict, this study examined the effects of N1-(bromoacetyl)-N8-[3-(4-indolyloxy)-2- hydroxypropyl]-(Z)-1,8-diamino-p-menthane (pindobind) 5-HT1A, a novel 5-HT1A antagonist, on agonistic and social behaviour in mice. Employing a resident-intruder paradigm, administration of pindobind 5-HT1A (0.5-10 mg/kg) to resident animals produced a reduction in offensive sideways and chasing behaviour. Defensive postures were unchanged except for evasion, which was reduced. Within social behaviour, nonspecific social behaviour and following behaviour were reduced while stretch/attend behaviour was enhanced. Nonsocial behavioural changes included an increase in resident cage exploration and rearing. Intruder data indicated no significant change in offensive behaviours, an attenuation of defensive sideways posturing and evasion, decreases in attend behaviour, and increases in cage exploration, rearing, and digging. Results are discussed in relation to the effects of 5-HT1A receptor (ant)agonism on murine offensive behaviour.

Exploratory celiotomy in 200 nontraumatized dogs and cats.

Two hundred dogs and cats undergoing exploratory celiotomy for reasons other than trauma were grouped by disease classification and by body system affected. There were 61 animals in which infection or inflammation predominated, 63 animals with neoplasia, and 76 animals with noninflammatory and non-neoplastic conditions. Body systems affected were digestive, lymphatic, urinary, reproductive, other, and undetermined. Seventy-three percent of the animals survived the hospitalization period; survival rates for animals with infection or inflammation, neoplasia, and other disorders were 69%, 60%, and 86%, respectively. Within the same groups, the exploratory celiotomy provided strictly diagnostic information in 72%, 79%, and 24% of the animals, and surgical treatment was provided to 28%, 21%, and 58% of the animals, respectively. Intraoperative cytologic and histologic diagnoses were consistent in 78% of the animals; the consistency rates for animals with infection or inflammation, neoplasia, and other disorders were 81%, 88%, and 59%, respectively. Complications after surgery were observed in 30% of the animals, with 60% of the complications disease related. Complications were observed in six animals with reproductive disorders (67%), six animals with urinary disease (46%), 35 animals with digestive disease (29%), and three animals with lymphatic disease (13%).

Surgical correction of pectus excavatum, using external splintage in two dogs and a cat.

Two 4-week-old pups and a 7-week-old kitten with respiratory distress and pectus excavatum were treated by external application of a coaptation splint to the ventral aspect of the thorax. Sutures were placed percutaneously around the sternum and through predrilled holes in a piece of moldable splint material that had been contoured to fit a normal-shaped thorax. Correction of the sternal deformity and alleviation of respiratory distress were achieved in all 3 animals. Frontosagittal index and vertebral index were assessed before and after surgery. In all 3 animals, both indices were abnormal before surgery, but were within the normal range after surgery.