In vitro embryo production: growth performance, feed efficiency, and hematological, metabolic, and endocrine status in calves.

The potential management benefits of in vitro embryo production have been offset by an increased incidence of health-related problems in resulting calves [increased birth weight, congenital abnormalities, and peri- and postnatal mortality (large-offspring syndrome)] and of recipient cows (prolonged gestation, dystocia, increased hydroallantois, abortion). The aim of the present research was to determine whether relevant metabolic, endocrine, or hematological traits could be related to the causes of enhanced growth performance of in vitro fertilized calves. Growth performance and feed efficiency as well as hematological, metabolic, and endocrine traits studied in calves derived from in vitro-produced embryos (IVP; n = 11) and in calves derived from artificial insemination (AI; n = 8). Donor cows from which oocytes for in vitro fertilization were obtained had a heterogeneous background, thus excluding genetic maternal influences. On the other hand, semen for in vitro fertilization and for artificial insemination was from the same bull, and recipient cows were held under the same husbandry and feeding conditions as AI cows, thus reducing the variability. Blood samples were collected preprandially on d 1, 2, 3, 4, 7, 14, 28, 56, and 112 of life and every 20 min between 0830 and 1630 h on d 7 and 112 for the evaluation of growth hormone secretory patterns. Gestation of IVP cows was longer than that of AI cows, but birth weights were similar in both groups. Feed intake, average daily gain, and body length during the experimental period, body weight from wk 8 to 16, and gain/feed ratio during the first month of life were higher in IVP than in AI calves. At birth, potassium, 3,5,3'-triiodothyronine, and thyroxine concentrations were lower in IVP than in AI calves. Concentrations of sodium and potassium on d 7, of triglycerides on d 28, and of albumin on d 56 were higher in IVP than in AI calves. In conclusion, IVP calves had higher feed intake and growth rate during the entire growth period and improved feed efficiency in the first month of life than AI calves, but this was not mirrored by consistent changes of hematological, metabolic, or endocrine traits, whose concentrations were in the normal range. Additional work is needed to study IVP calves under field conditions.

Third-party biller compliance guidance emphasizes risk awareness.

The voluntary compliance guidance for third-party billing companies released by the HHS Office of Inspector General (OIG) in December 1998, like the OIG's previously released guidance directed at hospitals, home health agencies, and clinical laboratories, identifies seven minimum elements for an effective corporate compliance program: written compliance policies, designation of a compliance officer, ongoing training, open lines of communication, guidelines to ensure the enforcement of compliance standards, internal monitoring and auditing of compliance activity, and procedures to respond to and correct errors. Three areas of concern for third-party billing companies are emphasized in the new guidance document: compliance risk, claims documentation, and disclosure of suspected misconduct or fraud.

[Panic disorders in the emergency room]. / Panikstörungen auf der Notfallstation.

Patients with panic disorder perceive physical symptoms which they interpret as dangerous phenomena; therefore, they normally seek help from physicians in somatic medicine and do not consult with a psychotherapist or psychiatrist. The combination of physical symptoms and catastrophic thinking induces such an intense feeling of anxiety that patients often visit an emergency unit. Thus, the prevalence of panic disorder is high among patients who seek help for heart symptoms within the setting of an emergency department (18%); in other clinical populations it may even be higher (patients with negative coronary angiography 33 to 59%, with irritable bowel syndrome 29 to 38%, with migraine headache 5 to 15%). Already in the emergency department it is possible to establish with the patient an understanding of the impact such catastrophic interpretations of basically benign physical changes have on the development of panic. This helps to avoid long-standing and expensive patient careers that have often been described in the literature. The present review includes a description of the cognitive model of the origin and the treatment of panic disorder as well as an overview of drug treatments with benzodiazepines and antidepressive drugs.

The Medicare and Medicaid anti-kickback law: charting your safe harbors.

The Medicare and Medicaid fraud and abuse provisions create many potential pitfalls for physicians; navigating around these problem areas can be tricky. This article discusses recently published federal regulations providing "safe harbors" from the anti-kickback provisions of Medicare and Medicaid law, with particular emphasis on the more common relationships between physicians and hospitals. Those safe harbors that are most and least useful to the physician are highlighted, and advice is offered for evaluating the relative risks involved where no safe harbor is available or fully applicable.

Increased serum high-density lipoprotein cholesterol in hypertensive men treated with the potent vasodilator carprazidil.

The effects of the potent arteriolar vasodilator carprazidil on serum lipoproteins and various clinical, biochemical and endocrine parameters were assessed in 15 men with mild to moderate essential hypertension. Following a carprazidil monotherapy (average dose 50 to 60 mg/d) of 8 weeks (N = 15) or 16 weeks (N = 12) duration, blood pressure was decreased significantly (P less than 0.01), while serum high-density lipoprotein cholesterol (+ 26% and + 24%, respectively; P less than 0.01) and the alpha-lipoprotein fraction (+ 26% and + 41%) were increased. Low- and very low-density lipoprotein cholesterol, triglycerides, as well as mean body weight, blood and plasma volume, heart rate, and plasma renin, aldosterone, norepinephrine, and epinephrine were not consistently altered. These results indicate that treatment of hypertensive men with carprazidil in modest dosage may have a favorable influence both on blood pressure and serum lipoproteins.

Combination chemotherapy of metastatic breast cancer: a randomized trial comparing the use of adriamycin to that of Vinblastine.

Two regimens of chemotherapy for metastatic breast cancer were compared in a randomized controlled fashion. Regimen 1 consisted of cyclophosphamide, vinblastine, methotrexate and 5-fluorouracil (CVMF). Regimen 2 consisted of cyclophosphamide, adriamycin, methotrexate and 5-fluorouracil (CAMF). The patient population consisted of both black and white postmenopausal females who had not received any prior chemotherapy. Objective responses were observed in 25/57 patients treated with CVMF and in 28/51 patients treated with CAMF. Neither race nor choice of chemotherapeutic regimen affected prognosis, although there were differences in the pattern of metastatic involvement between the two racial groups. The median duration of survival of patients who responded to therapy has not yet been reached but will be in excess of 12 months.

Certificate of need--is group practice next in line?

Certificate of Need agencies are likely to complicate the lives of group practice managers in the future--now is a good time to learn the nature of the beast.