Intimate partner violence and companion animal welfare.

OBJECTIVE: To investigate the effect of intimate partner violence (IPV) on companion animal welfare. DESIGN: Self-selected telephone survey of people meeting the criteria. METHODS: Members of the Australian public with experience of IPV and concurrent companion animal ownership were invited to telephone a researcher for a semi-structured interview. RESULTS: In total, 26 Australian women reported one or more companion animals in the household being verbally and/or physically abused by their male partner, usually with prolonged effects on animal behaviour; 92% indicated that they had been unwilling to discuss the animal abuse with a veterinarian. Many were unaware of animal accommodation services for people fleeing violence and those who did know about these were unwilling to use them, citing their bond with the animals as the main reason. Animals targeted for abuse were most likely to be dogs and owned by women rather than men, children or both partners. CONCLUSION: Animals can be severely affected by domestic violence situations and many people experiencing violence are unwilling to confide in veterinarians or seek help from animal shelters.

Prognostic implications of a biphasic waveform for APTT analysis in a district general hospital.

Activated partial thromboplastin time analysis creates waveforms of light transmittance against time. An abnormal biphasic waveform has been linked to morbidity and mortality. This study aims to quantify this link for patients in a district general hospital and determine the prognostic implications of the biphasic waveform. Data were collected over a 5-month period and analysed retrospectively to ascertain rates of infection, disseminated intravascular coagulation (DIC) and death. This was followed by a one month prospective study to assess prognostic implications. Rates of infection, DIC and death were high in this study population. The biphasic waveform often pre-empts these outcomes and is shown to be useful in predicting a poor prognosis.

Early discharge of patients with pulmonary embolism: a two-phase observational study.

The aim of the present study was to assess whether patients with pulmonary embolism (PE) could be managed as outpatients after early discharge from hospital using low molecular weight heparin instead of remaining as in-patients until effective oral anticoagulation was achieved. Phase 1 of the study identified criteria for the safe discharge of selected patients; phase 2 treated a cohort of low-risk patients with PE as outpatients with tinzaparin using existing deep venous thrombosis services. In phase 1, 127 (56.4%) of 225 patients were considered unsuitable for outpatient management. Reasons included: admission for another medical reason; additional monitoring or requirement for oxygen; bleeding disorders; previous PE/further PE while on warfarin; co-existing major deep venous thrombosis; likelihood of poor compliance; significant immobility; and pregnancy. In phase 2, 157 patients with PE received outpatient anticoagulation therapy. There were no deaths, bleeding or recurrent thromboembolic events during acute treatment with low molecular weight heparin. The median (range) length of hospital stay was 1.0 (1-4) day, with a median saving of 5.0 (1-42) bed-days per patient. Patients were highly satisfied with outpatient management; 144 (96.6%) indicated that they would prefer treatment as outpatients for a subsequent pulmonary embolism. Early discharge and outpatient management of pulmonary embolism appears safe and acceptable in selected low-risk patients, and can be implemented using existing outpatient deep venous thrombosis services.

Lymphoma presenting as a parotid tumour: a population-based study of diagnosis, treatment and outcome on behalf of the Scotland and Newcastle Lymphoma Group.

AIMS: Lymphoma presenting as a parotid tumour is rare. Previous published studies have been small and have not characterised fully the nature of lymphoma presenting this way. We studied the clinical features, diagnosis, prognosis and treatment in a patient group identified from the Scotland and Newcastle Lymphoma Registry, which is a prospectively collected population-based register of consecutive cases of lymphoma since 1979. MATERIALS AND METHODS: The study includes all patients with a biopsy-proven lymphoma in the parotid gland as the first presentation of their disease. RESULTS: Of 136 cases identified, 128 had non-Hodgkin's lymphoma (representing 1.5% of the 8499 non-Hodgkin's lymphomas in the registry) and eight had Hodgkin's disease (0.3% of the 2716 cases registered). Female to male ratio was 1.3:1, and median age was 69 years (range 19-94 years). Fifty-six per cent of patients had stage I, 16% had stage II, 11 % had stage III and 17% had stage IV disease. Diagnostic method was recorded in 81 cases; 47 of these were by parotidectomy. Overall median survival was 90 months, with a 5-year survival of 54%, but there was substantial variation according to age, grade, stage and International Prognostic Index (IPI). Diagnosis was often made by unnecessary major facial surgery, which could be avoided in many cases. CONCLUSION: Treatment should be directed by standard practice for lymphoma according to stage and histological classification.

Pregnancy rates in mares after a single fixed time hysteroscopic insemination of low numbers of frozen-thawed spermatozoa onto the uterotubal junction.

REASONS FOR PERFORMING STUDY: To compensate for the wide variation in the freezability of stallion spermatozoa, it has become common veterinary practice to carry out repeated ultrasonography of the ovaries of oestrous mares in order to be able to inseminate them within 6-12 h of ovulation with a minimum of 300-500 x 10(6) frozen-thawed spermatozoa. Furthermore, in order to achieve satisfactory fertility, this requirement for relatively high numbers of spermatozoa currently limits our ability to exploit recently available artificial breeding technologies, such as sex-sorted semen, for which only 5-20 x 10(6) spermatozoa are available for insemination. OBJECTIVES: This study was designed to evaluate and compare the efficacy of hysteroscopic vs. conventional insemination when low numbers of spermatozoa are used at a single fixed time after administration of an ovulation-inducing agent. METHODS: In the present study, pregnancy rates were compared in 86 mares inseminated once only with low numbers of frozen-thawed spermatozoa (3-14 x 10(6)) at 32 h after treatment with human chorionic gonadotrophin (hCG), either conventionally into the body of the uterus or hysteroscopically by depositing a small volume of the inseminate directly onto the uterotubal papilla ipsilateral to the ovary containing the pre-ovulatory follicle. RESULTS: Pregnancy rates were similarly high in mares inseminated conventionally or hysteroscopically with 14 x 10(6) motile frozen-thawed spermatozoa (67% vs. 64%). However, when the insemination dose was reduced to 3 x 10(6) spermatozoa, the pregnancy rate was significantly higher in the mares inseminated hysteroscopically onto the uterotubal junction compared to those inseminated into the uterine body (47 vs. 15%, P < 0.05). CONCLUSIONS: When inseminating mares with <10 x 10(6) frozen-thawed stallion spermatozoa, hysteroscopic uterotubal junction deposition of the inseminate is the preferred method. POTENTIAL CLINICAL RELEVANCE: Satisfactory pregnancy rates are achievable after insemination of mares with frozen-thawed semen from fertile stallions 32 h after administration of human chorionic gonadotrophin (Chorulon). Furthermore, these results were obtained when mares were inseminated with 14 x 10(6) progressively motile frozen-thawed spermatozoa from 2 stallions of proven fertility.

Massive haemolysis in a group A recipient of a group O peripheral blood stem cell allogeneic transplant.

A 28-year-old man with lymphoblastic lymphoma received G-CSF mobilized stem cells from his HLA identical sister, who had been taking methotrexate for psoriasis until 1 month prior to harvest. The recipient's blood group was A Rh D positive and donor's group O Rh D positive. Engraftment and major haemolysis were evident by day 9. From day 9 to day 13 he received 17 units of blood (approximately 3 L of red cells) at a time when his calculated red cell volume was 1 L. This massive transfusion requirement was not explained by his clinical condition and led us to consider factors that may have influenced the degree of haemolysis. The stem cell graft contained 2.85 x 10(6) CD34+ cells kg(-1) and we speculate there was B cell hyperactivity following the withdrawal of methotrexate in the donor and this went unchecked by the omission of methotrexate in the GVHD prophylaxis of the recipient. We have also considered the phenomenon of bystander haemolysis, previously unreported in this situation, as haemolysis of transfused group O blood must have also occurred. The case also illustrates the importance of transfusing donor type red cells and recipient type fresh frozen plasma (FFP) and platelets into minor mismatched transplant patients. The decision to revert to donor type FFP and platelets should only be made when the direct antiglobulin test is negative and the appropriate isohaemagglutinins are no longer demonstrable.

Acquired haemophilia complicating the remission of a patient with high grade non-Hodgkin's lymphoma treated by fludarabine.

We report the development of a high titre antibody to factor VIII in a patient with previous high grade B cell non-Hodgkin's lymphoma treated with fludarabine. Unlike previous reports of factor VIII inhibitors and lymphoproliferative disease this patient's lymphoma was in remission. We speculate that the occurrence of the inhibitor is another manifestation of the increasingly recognized autoimmune side-effects of fludarabine.

Cisplatin and acute tubular necrosis.

We report an unusually short lived and asymptomatic episode of severe cisplatin-induced renal tubular salt wasting in a fit 41-year-old patient with malignant teratoma. This was associated with polyuria but no significant hyponatraemia. Full recovery occurred because of early pick up, emphasizing the need for careful fluid balance monitoring of patients receiving cisplatin chemotherapy.