Molecular characterization and phylogenetic analysis of bovine viral diarrhea virus in dairy herds of Fars province, Iran.

Bovine viral diarrhea virus (BVDV) is one of the most important viral pathogens of cattle worldwide. The aim of present study was to determine the molecular characterization and phylogenetic analysis of BVDV infection in dairy herds of Fars province, Iran. For initial screening, a total of 400 blood samples were collected from 12 industrial dairy herds with previous history of diarrhea, abortion or birth of weak calves and analyzed using reverse transcription-polymerase chain reaction (RT-PCR) on buffy coat. In the next step, blood samples and also ear notch biopsies were collected from 100 cattle of infected farms three weeks later which were subsequently tested by antigen capture ELISA (ACE), RT-PCR and immunohistochemistry (IHC). The results of nested RT-PCR were successful in 16 out of 400 buffy coat samples (4%) in the initial screening. Also, 8 out of 100 samples (8%) were positive by all practiced tests including RT-PCR, ACE and IHC on buffy coat, serum and skin samples, respectively. Immunoreactivity for bovine BVDV antigen as brown, coarsely to finely granular was observed within the cytoplasm of epidermic epithelial cells, hair follicles and subcutaneous stromal cells. Genetic sequence analyses showed both genotypes, BVDV-1 and BVDV-2. The new isolates were identified as BVDV1-FarsA, BVDV1-FarsB and BVDV2-FarsA in the phylogenetic tree. Since both genotypes of the virus are present in the region, our findings emphasize the importance of monitoring BVDV infection in cattle and suggest detection and elimination of PI animals for controlling and eradication of BVDV in Fars province.

Larval cyathostominosis in a working donkey.

Parasitic infections are one of the most common factors that threaten the health and working performance of donkeys. One of the life threatening parasites is the small strongyles that encyst or burrow into the large intestine and their larvae can initiate severe damage in the lining of the intestine. A 6 years old female donkey with clinical signs of diarrhea and emaciation was necropsied and gross examination of gastro-intestinal tract revealed thin-walled, hyperemic and hemorrhagic cecum. Multifocal petechial hemorrhages were particularly prominent in the submucosa of cecum. Parasitological examination revealed two cyathostomin species included Cylicocyclus elongatus and Cyathostomum pathratum. At microscopic examination, cross sections of cyathostomins larvae associated with parasitic granuloma were observed in the submucosa of cecum. The lesions were associated with non-suppurative enteritis with infiltration of eosinophils, plasma cells, lymphocytes and macrophages in the intestinal mucosa, submucosa and lamina propria.

Mosaicplasty for the treatment of articular defects of the knee and ankle.

Efficacious treatment of full-thickness cartilage defects of the weightbearing surfaces is a multi-faceted challenge for the orthopaedic surgeon. Autologous osteochondral transplantation represents one solution: to bring about a hyaline or hyalinelike repair of the defected area. The current authors discuss the experimental background and their 8 years of clinical experience with the autologous osteochondral mosaicplasty. Several series of animal studies and subsequent clinical practice have confirmed the survival of the transplanted hyaline cartilage. Hyaline cartilage and fibrocartilage fill the donor sites located on the nonweightbearing surfaces and surfaces that bear less weight. Clinical scores, imaging techniques, control arthroscopies, histologic examination of biopsy samples, and cartilage stiffness measurements were used to evaluate the clinical outcomes and quality of the transplanted cartilage. According to these investigations, femoral condylar implantations have shown good to excellent results in 92%, tibial resurfacing in 88%, patellar and/or trochlear mosaicplasties in 81%, and talar procedures in 94% of patients. The Bandi score showed long-term donor site disturbances in 3% of patients. Fifty-eight of the 68 control arthroscopies had good gliding surfaces, histologically-proven survival of the transplanted hyaline cartilage, and fibrocartilage covering of the donor sites. In the entire series, there were four deep infections and 34 painful hemarthroses after surgery. A multicentric, comparative, prospective evaluation of 413 arthroscopic resurfacing procedures (mosaicplasty, Pridie drilling, abrasion arthroplasty, and microfracture cases in homogenized subgroups) showed that mosaicplasty gave a more favorable clinical outcome in the long-term followup, than the other three techniques. Intermediate-term evaluation of the femoral condylar implantations (3-6-years followup) and talar mosaicplasties (3-7-years followup) confirmed the durability of the early results. From these encouraging results from an increasingly large series and similar results from other centers, it seems that autologous osteochondral mosaicplasty may be a viable alternative treatment of localized full-thickness cartilage damage of the weightbearing surfaces of the knee and other weightbearing synovial joints.

Mosaicplasty for the treatment of osteochondritis dissecans of the talus: two to seven year results in 36 patients.

An osteochondral defect (OCD) is known as a symptomatic lesion causing pain, recurrent synovitis, and altered joint mechanics most commonly in a weight-bearing joint. Loose bodies may develop, which may then cause joint destruction and/or locking. The damage to the articular surface is most likely a precursor of ankle osteoarthritis. With the recent advances in diagnostic imaging, such as MRI, as well as the development of ankle arthroscopy, the identification and classification of these lesions has become much more precise. This allows more accurate staging and improves treatment recommendations. The assessment of a particular treatment is also improved. A variety of treatment alternatives are now available. These include arthroscopic procedures including debridement, retrograde drilling, and bone grafting. Compared to open treatment, arthroscopic procedures may be particularly advantageous in the treatment of small defects and stable OCD lesions. Until recently, however, favorable results have been less predictable for large or unstable osteochondral defects. We treat these more difficult lesions with a mosaic autogenous osteochondral transplantation. In our hands, this appears to provide an optimal treatment result. The present report evaluates the clinical outcome of 36 patients followed for two to seven years after a mosaicplasty autogenous osteochondral transplantation from a non or less weight bearing portion of the knee to the ipsilateral talus. Ankle function was measured by the Hannover scoring system and showed good to excellent results in 34 cases (94%) with no long term donor site morbidity. The encouraging clinical results are supplemented with radiographs and histology, which support the premise of lasting relief of symptoms and prevention of ankle arthrosis.

Pulmonary veins-left atrial junction: anatomic and histological study.

Pulmonary veins (PVs) are the target of ablation procedures to cure paroxysmal atrial fibrillation (PAF). There are few anatomic and histological studies of PVs. Sixteen human hearts were obtained from autopsies performed at our hospital and cadavers from a local medical school. The anatomic relationship between the PVs and the left atrium (LA) was categorized according to the spatial orientation of the veins within horizontal and vertical planes viewed from the dorsal aspect of the LA. The PVs were sectioned longitudinally, and the sections were stained with hematoxylin and eosin. In addition, selected sections were stained with antismooth muscle antibodies (vessel wall), antipankeratin, and antimyoglobin antibodies (myocardium). The PV-LA junction has variable orientations. Confluent superior and inferior veins, observed in 25% of the hearts, were more common on the left side. A myocardial sleeve extended from the LA onto the adventitial surface of the PV. The sleeve was distinct from the smooth muscle in the PV media, from which it was separated by loose fibrous strands. There was no microscopical boundary between the PV and the LA endocardium. The PV join the LA at variable angles. Each PV is surrounded by a myocardial sleeve extending from the LA.

Osteochondral mosaicplasty for the treatment of focal chondral and osteochondral lesions of the knee and talus in the athlete. Rationale, indications, techniques, and results.

New techniques for articular cartilage transplantation have become available recently for traumatic chondral injuries. Applications to the athlete have generated considerable interest in the sports medicine community. The autogenous osteochondral grafting mosaicplasty has been used to treat these injuries in the athlete population for the past six years. The rationale, indications, operative technique, results, and limitations of mosaicplasty in the athlete are presented and discussed.

Mosaicplasty for the treatment of articular cartilage defects: application in clinical practice.

This article describes a one-step operative technique for the treatment of circumscript cartilage defects of weight-bearing surfaces of the knee. Since 1992, a total of 227 patients were treated using this technique for full-thickness lesions resulting from chondropathy, traumatic chondral defects, and osteochondritis dissecans; the procedure was evaluated in 57 patients who had > 3 years of follow-up. Magnetic resonance imaging, computed tomography arthrographies, ultrasound, and arthroscopy were used to evaluate the technique. Using the modified Hospital for Special Surgery (HSS) knee scoring system, 91% of the patients achieved a good or excellent result. The operative technique, clinical results, and complications are detailed.

Treatment of osteochondritis dissecans of the talus: use of the mosaicplasty technique--a preliminary report.

A one-stage autogenous osteochondral grafting technique for the treatment of talar dome osteochondritis dissecans is described. Eleven patients with osteochondritis dissecans lesions, 10 mm or greater in diameter, were operated on using the mosaicplasty autogenous osteochondral transplantation technique. Osteochondral cylindrical grafts from the ipsilateral knee were delivered into the talar defect using specially designed tube chisels. These procedures were done by arthrotomy. With follow-up of 12 to 28 months (mean, 16 months), the patients returned to full activities and the results, using the Hannover scoring system, have been excellent.

Arthroscopic autogenous osteochondral mosaicplasty for the treatment of femoral condylar articular defects. A preliminary report.

An arthroscopic technique for the use of mosaicplasty osteochondral grafting in the treatment of femoral condylar articular defects is described. During the procedure, small cylindrical grafts are harvested from the nonweightbearing periphery of the patellofemoral joint and implanted in mosaiclike fashion into the focal cartilage defect of the weightbearing condylar surface. This report describes the arthroscopic technique using newly designed instruments and the early results of 44 patients treated by this method. Good to excellent results have been obtained based on follow-up ranging from 1 to 5 years. The modified HSS scores are compared with a control group consisting of patients treated by abrasion arthroplasty. Evaluation was done clinically and, in some cases, by ultrasound, magnetic resonance imaging, 3-dimensional computed tomography. The results of 10 control arthroscopies and the histological evaluations of 6 biopsies demonstrated the hyalinelike cartilage surface at the recipient area and the fibrocartilage formation at the surface of the donor holes.

Duplex scanning of the inferior epigastric artery.

PURPOSE: The inferior epigastric artery (IEGA) has been used as a conduit for coronary artery bypass grafting. Because of varying lengths, diameters, and depths, a method of determining vessel adequacy before operation was needed. METHOD: A BioSound Phase II scanner (BioSound, Indianapolis, Ind.) with a 10 MHz probe was used to image the IEGA in 40 patients. Beginning at the common femoral artery and moving superiorly, the external iliac artery is identified with its first branch, which is the IEGA. The IEGA is located deep in the rectus muscle, along the posterior rectus sheath. Frequent measurements of the diameter and depth are taken along the length of the IEGA. RESULTS: When comparing the group of patients in whom there was operative confirmation of the ultrasound findings, we found, on the right side, a mean length of 9.0 cm and mean diameter of 2.4 mm by ultrasonography and 10.5 mm and 2.4 mm at operation. On the left side the findings were 9.6 cm and 2.6 mm by ultrasonography and 11 cm and 2.6 mm at operation. There was one wound complication in an IEGA harvest site that had a body wall thickness of less than 4 cm (1/23; 4.2%), but all four sites with a body wall thickness of 4 cm or greater developed wound complications (4/4; 100%). CONCLUSION: The use of duplex scanning of the IEGA before operation provided excellent information about the length, diameter, depth, and patency of the vessel. Preoperative scanning prevented unnecessary dissection when the IEGA was not of adequate length or diameter. It was also very useful in providing information regarding risk of wound complications in obese patients.

Clinical meaning of the Keane PTSD Scale.

A correlational study that included 82 male inpatient alcoholics was conducted to determine the clinical meaning of the Keane PTSD Scale of the MMPI. The PTSD Scale was correlated with the variables of the Shipley Institute of Living Scale, the Life Purpose Questionnaire, the Existential Depression Test, and the standard MMPI measures, plus the A, R, Es and MacAndrew Scales. The pattern of correlations suggested that the PTSD scale measures general psychological maladjustment and dysphoric feelings rather than any specifiable syndrome. The strong correlation with the Welch A, which measures a general level of maladjustment, suggests that the PTSD and Welch A scales are measuring the same factor. The PTSD scale, therefore, appears to provide very little information about this population beyond that available from the overall clinical profile and the Welch A scale.

Cardiac tumors in 19 years of private practice.

Since 1966 the authors have encountered nine cardiac tumors: eight myxomas and one tumor initially thought to be a sarcoma but histologically a squamous carcinoma. Seven myxomas were left atrial and the other were right atrial in location. The carcinoma was predominantly located in the right ventricle. Eight of the nine patients were female; ages ranged from 32 to 85 years. Of the myxomas, five displayed fever and dyspnea, two congestive heart failure and one transient ischemic episodes. The patient with carcinoma was in right heart failure. All patients underwent cardiac catheterization as well as echocardiography when it became available. Five myxomas were correctly diagnosed preoperatively while three were thought to have mitral stenosis. The patient with carcinoma showed a large right ventricular filling defect and a picture of constriction. All myxoma patients underwent surgery--three via left thoracotomy and five via sternotomy. Seven patients survived; however, the patient with right atrial myxoma was explored via the left chest for mitral stenosis and the myxoma was not discovered. She died of a pulmonary embolism pathologically confirmed as myxoma. All survivors have been followed by yearly echocardiograms and are free of recurrence. The patient with carcinoma died before surgery could be performed. Autopsy revealed almost complete replacement of the right ventricle by tumor and constrictive pericarditis. The terminal event was pulmonary embolus of squamous carcinoma. Although cardiac tumors are a rare entity, a high incidence of suspicion plus modern diagnostic methods can yield the diagnosis and allow a curative operation.

Clinical assessment of the St. Jude medical cardiac prosthesis. A 5-year experience.

Mechanical prosthetic valves have established their long-term durability, but the incidence of thromboembolism has been less satisfying. Therefore, the search for the perfect valve continues. The choice of replacing a cardiac valve with a prosthetic valve is based upon its hemodynamics, durability, thromboembolic and hemolytic characteristics. The hemodynamic assessment of the St. Jude Valve demonstrates that it performs well in the aortic, mitral, and tricuspid positions. The central bileaflet flow design leads to minimal gradients, even in the small valves which make it ideal for its use in children. The purpose of its all-pyrolite construction is to decrease the incidence of thromboembolism. Replacement of heart valves with the St. Jude Medical prosthesis was initiated in April, 1979. An analysis of all patients undergoing valve replacement between April 1, 1979, and June 1, 1984, was carried out to assess the durability, incidence of thrombosis, and thromboembolic as well as other complications.

Long-term survival with ventricular pacemaking: initial 15-year experience.

The records of all 380 adult patients receiving cardiac pacemakers at West Virginia University in the 15-year period ending January 1, 1977, were reviewed. The five-year survival rate was 58 per cent and the 10 year, 38 per cent with a median survival of 74 months. Life expectancy approached life-table curves if the mortality during the initial year was ignored. Although the younger patients lived the longest, their expected survival was reduced more than in the older patients. The need for a pacemaker in a young person implies serious life-shortening consequences. Unlike reports in the literature, patients with sinoatrial disease fared worse than those with A-V block.

Coarctation of the thoracic aorta: an 18-year experience.

From 1960 to 1978, 80 patients from 2 weeks to 49 years of age underwent operations for coarctation of the aorta. Twelve patients were under 3 months old, and 68 were older. All of the infants presented with congestive heart failure and multiple cardiac defects. In the older patients, hypertension was the most common presenting symptom; 14 were asymptomatic. All patients under 3 months old received primary correction. Seven (58%) died of complications associated with other cardiac anomalies. In the older group, there was 59 primary reconstructions, six interposition grafts, and three other procedures. There were two deaths in this group. There were three re-explorations, two for bleeding and one for false aneurysm at the suture line. Seven older patients exhibited paradoxical hypertension: three developed abdominal symptoms and two required laparotomy. Three patients originally operated on during infancy developed recurrent coarctation with reoperation in two. Nine of the older patients had chronic hypertension, all of whom were operated on after age 15. Surgical correction of coarctation in infants carries a high mortality rate secondary to associated defects. The operative mortality rate in older patients is minimal, and correction should be undertaken early to prevent the long-standing complications of hypertension.

Alcoholics' recovery from cerebral impairment as a function of duration of abstinence.

There is clear evidence in the literature for permanent cerebral impairment due to prolonged alcohol abuse. Observation also suggests that there is a component of this cerebral impairment that is found immediately subsequent to heavy drinking and that is reversible. This study examined the time-course of recovery from this temporary impairment and delineated more specifically the neuropsychological functions that participate in the recovery. Four groups (N = 87) of hospitalized male alcoholics were tested after 6, 15, 21, and 110 days of abstinence using the Raven Progressive Matrices, the Trail-Making Test, the Memory for Designs, and the following subscales of the WAIS: Arithmetic, Digit Span, Block Design, Similarities, and Digit Symbol. The results indicated that significant improvement occurred during the third week of abstinence (between 15 and 21 days) on the Digit Span, Block Design, Similarities, Memory for Designs, Raven, and Trail-Making tests, but not on the Arithmetic and Digit Symbol tests. These results suggest that treatment programs that use a preliminary "drying-out" period should consider lengthening this period to 3 weeks to insure that patients are maximally responsive to psychotherapy.