Transvaginal endometrial sonography in postmenopausal women taking tamoxifen.
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Endometrium↗
Biomedical subjects
A Steiner
Publications and source records attributed to A Steiner.
[Physical examination of ruminants showing signs of abdominal pain].
This paper presents a review of the pathogenesis of abdominal pain in ruminants, the complete clinical examination of animals with colic and the symptomatology of the different conditions producing abdominal pain. Further diagnostic procedures such as abdominal ultrasonography, explorative laparotomy and diagnostic laparoscopy are discussed.
Abdominal Pain↗
[Diagnostic laparoscopy in the cow].
This paper describes the technique of laparoscopy in cows. The laparoscopic anatomy of healthy cows is described with the laparoscope introduced through the left and right flank in the standing animal and through the ventral aspect of the abdomen with the animal positioned in dorsal recumbency. The case reports and the corresponding laparoscopic findings of 4 cows suffering from an intraabdominal problem are additionally presented.
Abdomen↗
[New aspects on the etiopathogenesis and treatment of cecal dilatation/-dislocation in cows--a review].
This paper describes the latest results of research in the areas of etiopathogenesis and treatment of cecal dilatation/-dislocation (CDD) in cows. Similar etiopathogenic mechanisms of CDD and displacement of the abomasum, as has been hypothesized in the literature, were not confirmed. Spontaneous CDD is most likely the consequence of a dysfunction of the spiral colon. Bethanechol is an appropriate motility-modulating drug for medical and postsurgical treatment of spontaneous CDD.
Animals↗
[Epidemiology and risk factors of cecal dilatation/dislocation and abomasal displacement in dairy cows].
The aims of the study were to determine the prevalence of cecal dilatation/dislocation (CDD) and abomasal displacement (DA) in Switzerland, to identify risk factors for both diseases, and to compare directly their epidemiologic situation. The epidemiologic study included 158 cases of CDD and 149 cases of DA from the cases referred to both University Clinics of Berne and Zurich. The results showed that DA was associated with nutrition-related risk factors: use of minerals and sodium chloride, inadequate concentrate feeding and beginning of the feeding. Furthermore, breed was significantly associated with DA, but not with CDD. Finally, milk yield and pasture were also significantly included in the models. For CDD, nutrition-related risk factors were also found: pasture in summer, use of corn pellets and corn silage in winter. In the final model, protein concentrate was also included. Although both diseases were found at comparable frequencies, the results of this study indicate marked differences between the epidemiology of occurrence of CDD and DA. Therefore, the hypothesis of a common etiopathogenesis appears unlikely.
Animals↗
Concentration of volatile fatty acids in digesta samples obtained from healthy cows and cows with cecal dilatation or dislocation.
OBJECTIVE: To compare concentrations of acetic, propionic, butyric, and i- and n-valerianic acids in digesta samples obtained from the rumen, cecum, proximal loop of the ascending colon (PLAC), and rectum of healthy cows and cows with cecal dilatation or dislocation (CDD). ANIMALS: 20 cows with CDD and 20 healthy cows. PROCEDURE: Samples were collected from all sites during surgical correction of CDD and also from the rectum 1, 2, and 3 days after surgery (group CDD). Samples from healthy (control) cows, matched on the basis of diet and milk yield, were obtained at a slaughterhouse. Concentrations of volatile fatty acids (VFA) were analyzed by use of gas chromatography. Absolute concentration of each VFA was additionally corrected for pH to allow calculation of the concentration of undissociated VFA. RESULTS: Absolute concentration and concentration of the undissociated form of all analyzed VFA were significantly increased in samples collected from the cecum and PLAC of cows in group CDD, compared with concentrations for control cows. Within 3 days after surgery, significant decreases of the absolute concentration of butyric, i- and n-valerianic acids, and undissociated i- and n-valerianic acids were evident in samples obtained from the rectum of group-CDD cows. Concentrations of VFA in samples obtained from the rectum during surgery correlated with corresponding VFA concentrations in samples obtained from the PLAC. CONCLUSIONS: Concentrations of VFA are increased in the cecum and PLAC of cows with CDD. However, the role of increased concentrations of VFA in the etiopathogenesis of CDD is unknown.
Animals↗
Permanent implantation of a reinforced polytetrafluoroethylene vascular graft for treatment of artificial defects of the teat cistern mucosa in cows.
OBJECTIVE: To evaluate use of a reinforced polytetrafluoroethylene vascular graft for treatment of an artificial defect of mucosa of the teat cistern in lactating cows. DESIGN: Prospective study. ANIMALS: 9 clinically normal lactating dairy cows. PROCEDURE: A 20-mm wide circumferential area of mucosa was sharply excised from the cistern of 1 teat on each cow 10 days after spontaneous calving, and the lesion was covered by a graft. After 14 days of passive milk drainage, routine milking was resumed. Follow-up examinations were performed during the next 2 lactation periods and included evaluation of wound healing, location and sonographic appearance of the implant, milk flow and yield, and somatic cell counts. Cows were slaughtered, and teats and mammary glands were examined microscopically. RESULTS: Implants had partially to totally collapsed within 30 to 90 days. Milk flow was significantly increased by day 15 of the first lactation, but decreased significantly by day 300 of lactation 1. At the end of lactation 1, milk flow had ceased in 3 out of 7 quarters. Only 3 of 9 quarters drained through grafted teats were milkable at the end of the study. Somatic cell counts of these quarters were significantly increased in the first lactation period. At necropsy, 2 grafts were in the teat cistern, but only 1 was incorporated into the mucosa by connective tissue. The mucosa was thickened in all teats with grafts, and there was epithelial metaplasia and granulation tissue proliferation. CLINICAL RELEVANCE: Use of a polytetrafluoroethylene graft can preserve patency in the first lactation period. However, the graft may not be sufficiently incorporated into the mucosa if routine machine milking is resumed 2 weeks after implantation. )
Animals↗
The Gomco circumcision: common problems and solutions.
Circumcision performed using the Gomco clamp is usually quick and effective, and results in very little bleeding. However, every clinician performing circumcision occasionally has concerns or questions regarding the procedure. Some of the more common concerns regarding the use of the Gomco clamp are technique-related, including choosing the correct size of the Gomco bell and clamp for the procedure, choosing the right method of getting the foreskin properly through the hole of the Gomco base plate, and assessing how much foreskin to remove. Other concerns include poor cosmetic results, contraindications to routine circumcision, and circumcision in an infant whose mother has human immunodeficiency virus. This article reviews the technique of circumcision using the Gomco clamp and answers some of the more common questions.
Circumcision, Male↗
Implantation of a reinforced polytetrafluoroethylene vascular graft for treatment of obstructions of the teat and mammary gland cisternae in cattle.
OBJECTIVE: To evaluate use of an artificial vascular graft as treatment for obstructions of the teat and mammary gland cisternae in lactating cattle. DESIGN: Prospective clinical study. ANIMALS: 14 lactating dairy cows. PROCEDURE: After physical examination that included palpation, ultrasonography, evaluation of milk flow, and California mastitis test, each cow underwent surgical excision of obstructive tissue and implantation of a reinforced polytetrafluoroethylene vascular graft. Milk drained passively for 10 to 14 days after surgery. Follow-up evaluation was performed by telephone questionnaire of owners 1, 6, and 12 months after surgery regarding somatic cell count, time needed to milk affected quarter, compared with that of the contralateral quarter, and frequency of mastitis. After the subsequent nonlactation period and calving, milk flow was tested, using a quarter milking machine, and ultrasonographic examination of the affected teat was performed. RESULTS: Milk could be obtained from affected quarters from all cows 14 days after surgery, from 13 (93%) cows 1 month after surgery, from 10 (71%) cows 6 months after surgery, and from 3 (21%) cows 12 months after surgery, but milk flow in these 3 cows was considerably reduced. This technique failed because of collapse of the implant (4 cows), chronic mastitis (1), migration of the implant (4), and ingrowth of obstructive tissue between the distal aspect of the implant and the ridges of mucous membrane that radiate from the internal orifice of the streak canal (4), or a combination of these. CLINICAL IMPLICATIONS: Implantation of this vascular graft is a useful technique to restore teat patency for 6 months. A longer period of passive drainage of milk appears necessary for sufficient ingrowth of the graft. Lesions that extend to the distal most aspect of the teat cistern have a poor prognosis, because this area cannot be sufficiently overlapped by the graft.
Animals↗
Treatment of infectious arthritis of the radiocarpal joint of cattle with gentamicin-impregnated collagen sponges.
Gentamicin-impregnated collagen sponges were used successfully in the treatment of chronic septic arthritis of the radiocarpal joint in two cattle. Both animals were moderately to severely lame and refractory to systemic antibiotics, and one of them was refractory to joint lavage and local antibiotics. The clinical diagnosis was confirmed by radiography and arthrocentesis. Arthroscopy was performed under general anaesthesia and, after debridement and lavage of the joint, gentamicin-impregnated collagen sponges were placed intra-articularly. Synovial fluid was sampled at 10 and 20 days after surgery and radiographs were taken three months (case 1) and two months (case 2) after surgery. The infection was eliminated from both animals and they recovered without residual lameness.
Animals↗
Molecular and functional characteristics of MAP-2a: ability of MAP-2a versus MAP-2b to induce stable microtubules in COS cells.
Microtubule-associated protein-2 (MAP-2) is a prominent cytoskeletal protein in the mammalian nervous system. Two high-molecular-weight (HMW) MAP-2 isoforms, MAP-2a and MAP-2b, are developmentally regulated. MAP-2b is expressed through the life of the neuron, while MAP-2a expression coincides with the time of synaptic formation. MAP-2a and MAP-2b differ in size by approximately 10 kD. Attempts to differentiate MAP-2a from MAP-2b led to the identification of additional exons; exons 7A, 8, 13, and 16. The focus of the present study was to define the complete molecular composition of MAP-2a that was prerequisite for investigating the functional characteristic of the MAP-2a protein. Detailed examination of rat brain mRNA by Northern blot analysis and RT-PCR showed that MAP-2a contains only exon 8 in addition to the exons found in the MAP-2b transcript. Exons 7A, 13, and 16 are not present in the MAP-2a transcript. Antibody generated to exon 8 expressed protein, immunoprecipitated a HMW protein from adult rat brain that co-migrated with MAP-2a and was immunopositive with other MAP-2 antibodies. Comparative transfections of full-length MAP-2a and MAP-2b cDNA into COS-7 cells demonstrated that MAP-2a influenced the microtubule network differently than MAP-2b by inducing rapid and stable microtubule bundle formation even in the presence of nocodazole.
Animals↗
Acute effects of 10-minute exposure to hydrogen fluoride in rats and derivation of a short-term exposure limit for humans.
A series of acute inhalation exposures of female rats was conducted with hydrogen fluoride (HF) to establish a concentration-response curve for nonlethal exposures. Durations of 2 and 10 min were used to simulate possible short-term exposures. Concentrations of HF ranged from 593 to 8621 ppm for 2-min exposures and from 135 to 1764 ppm for 10-min exposures. Additional exposures were performed for 60 min at 20 and 48 ppm HF for comparison to existing Emergency Response Planning Guidelines. Animals were evaluated on the day after exposure for changes in parameters of bronchoalveolar lavage, pulmonary function, hematology, serum chemistry, body weight, organ weights, and histopathology. Most exposures were performed with orally cannulated animals to bypass absorption of HF in the nose and achieve maximum delivery of HF to the lower airways. One of the primary uses of the resulting data was to estimate a concentration to which most people could be exposed for 10 min without severe of irreversible health effects. This level was 130 ppm. It was predicted that irritation would occur at this concentration, but the effects on t he respiratory tract would not be "serious" and would be expected to be reversible. The results of this experiment and the subsequent analysis of the data provide an important aid in he planning of responses to an accidental release of HF.
Animals↗
Effect of different prostaglandins on intrauterine pressure and uterine motility during diestrus in experimental cows.
Prostaglandins are widely used in herd management due to their luteolytic properties. They have also a direct effect on the myometrium. We hypothesized, that dissimilar prostaglandin preparations would differ as to their contractile effect. Intrauterine pressure was recorded during the diestrus of lactating dairy cows using a transcervically placed intraluminal pressure microtransducer. After recording physiologic uterine motility for 30 min, prostaglandins (dinoprost, DL-cloprostenol, D-cloprostenol) or a placebo was administered intramuscularly, followed by a 2-h recording period. Significant differences were found for the area under the curve (P < or = 0.05) and mean amplitude (P < or = 0.05), whereas the number of spikes per 15 min and the baseline pressure during the last 3 min of every recording period did not differ significantly among treatments. Peak values for area under the curve and mean amplitude were found between 15 and 30 min after administration of DL-cloprostenol, while dinoprost yielded the steadiest plateau from this period until the end of the recording session. These results contrast with those of earlier studies comparing prostaglandins after intravenous administration.
Animals↗
Treatment of metastatic malignant melanoma with dacarbazine plus fotemustine.
Despite the poor prognosis of metastatic malignant melanoma, polychemotherapy with dacarbazine and fotemustine has shown promising results in several studies. We report on the clinical efficacy of a new sequential administration regimen with dacarbazine at a dose of 200 mg/m2 followed 24 h later by fotemustine 100 mg/m2 every 4 weeks in 63 patients with metastatic melanoma. A complete response was noted in 3 patients (5%), a partial response in 4 patients (6%), stable disease in 33 patients (5%) and progressive disease in 23 patients (37%). The duration of the 3 complete responses was 5, 14+ and 60+ months, for the 4 partial responses, 3, 4, 6 and 13 months. The median duration for stable disease was 4 months. The best response rates were obtained for lung and lymph node metastases. Toxicity was mild and mainly limited to haematological without pulmonary side-effects. Although there was a relatively low objective response rate, this chemotherapy regimen as a palliative treatment, is potentially valuable for patients with progressive stage IV melanoma.
Adult↗
Estimation of the volume-weighted mean nuclear volume discriminates keratoacanthoma from squamous cell carcinoma.
Keratoacanthoma (KA) is a fairly common neoplasm that in the past has been considered by many to be benign. Keratoacanthoma is usually differentiated from squamous cell carcinoma (SCC) by histopathologic criteria. However, the cytologic features of KA and SCC are often similar. Hence, KA may be confused with SCC at the histopathologic level. Volume-weighted mean nuclear volume (Vv) is determined by a technique that permits an unbiased and efficient estimation of nuclear volumes in tissues without any assumptions regarding nuclear shape. In this study, the volume-weighted mean nuclear volume was determined in 18 KAs and 19 SCCs to investigate whether this stereologic approach may be of use in the differentiation of these two tumors. Vv was determined by computer-assisted image analysis (IBAS 20, Kontron, Germany) on Feulgen-stained sections employing stereologic estimation of the volume-weighted mean nuclear volume. The mean Vv of KA was 704.5 microm3 (SD +/-170.5), whereas SCC exhibited a significantly lower Vv of 533.9 microm3 (SD+/-164.9) (p = 0.006). The sensitivity and specificity of Vv for the discrimination between KA and SCC was 0.80 and 0.78, respectively. We found that KAs show a significantly larger Vv than SCCs and thus, the estimation of the volume-weighted mean nuclear volume may be regarded as a helpful tool for the differential diagnosis of KA and SCC.
Aged↗
Epiluminescence microscopy-based classification of pigmented skin lesions using computerized image analysis and an artificial neural network.
Epiluminescence microscopy (ELM) is a non-invasive technique for in vivo examination which can provide additional criteria for the clinical diagnosis of pigmented skin lesions (PSLs). In the present study we attempt to determine whether PSLs can be automatically diagnosed by an integrated computerized system. This system should recognize the PSL, automatically extract features and use these features in training an artificial neural network, which should--if sufficiently trained--be capable of recognizing and classifying a new PSL without human aid. One hundred and twenty images of randomly selected histologically proven PSLs (33 common naevi, 48 dysplastic naevi and 39 malignant melanomas) were used in this study. The images were digitally obtained and the morphological features of the PSLs were extracted electronically without human assistance. The numerical data were then divided into learning and testing cases and linked to an artificial neural network for training and for further classification of lesions that the system had not been trained on. Our results show that the computerized system was able to automatically identify 95% of the PSLs presented. The sensitivity and specificity of the computerized system were 90% and 74% respectively. In contrast, when differentiating between individual types of lesions, the system performed at true positive rates of only 38% for malignant melanoma, 62% for dysplastic naevi and 33% for common naevi. Our data indicate that (1) ELM images of PSLs provide an excellent source for digital image analysis; (2) the vast majority of PSLs can be correctly identified by a relatively simple (and thus not "intelligent") application of digital image analysis; (3) automatic feature extraction based mainly on ABCD rules provides reliable data on the distinction between benign and malignant PSLs; and (4) there is evidence that artificial neural networks can be trained to adequately discriminate between benign and malignant PSLs.
Dysplastic Nevus Syndrome↗
Managed care: US research evidence and its lessons for the NHS.
OBJECTIVES: To review the high quality US evidence on performance of managed health care organisations and the available US evidence on specific managed care techniques; namely, financial incentives, utilisation management and review, physician profiling and disease management. METHODS: Literature searches were conducted using numerous databases including Medline, Embase, the Social Sciences Citation Index and the National Health Service (NHS) Centre for Reviews and Dissemination library. For inclusion of evaluations of overall performance, studies had to use a comparison group (typically fee-for-service patients), make appropriate statistical adjustments for differences between groups, and be published in a peer-reviewed journal from 1980 forward. For assessments of techniques, less-demanding inclusion criteria reflected the paucity of generalisable literature; however, more current results were required (1990 forward). RESULTS: We identified 70 articles for systematic review, covering 18 dimensions of performance (e.g. utilisation, quality of care, consumer satisfaction, equity). The strength of the evidence varied by dimension. It was strongest for utilisation and quality. In general, managed care seems to reduce hospitalisation and use of high-cost discretionary services, to increase preventive screening, and to be neutral in terms of patient outcomes. As for specific techniques, we identified 19 articles for review, but limitations of these studies prevented our drawing any definite conclusions about techniques' effectiveness. This is an important, if somewhat negative, conclusion. CONCLUSIONS: Applying US evidence is complicated by an irrelevant comparator and a higher baseline of utilisation. Managed care brought Americans the familiar NHS practices of population-based health care and resource management through gatekeeping; hence, changes due to UK adoption of managed care techniques may be modest. US evidence should be used to generate hypotheses, not to predict UK behaviour.
Disease Management↗
Adjuvant interferon alfa-2a treatment in resected primary stage II cutaneous melanoma. Austrian Malignant Melanoma Cooperative Group.
PURPOSE: Patients with primary cutaneous melanoma with a Breslow thickness > or = 1.5 mm have only a 30% to 70% probability of survival after surgery, and no adjuvant therapy has so far improved this outcome. Since interferon alfa-2a (IFNalpha2a) exhibits antitumor activity in metastatic melanoma, we investigated whether adjuvant IFNalpha2a diminishes the occurrence of metastases and thus prolongs disease-free survival in melanoma patients after excision of the primary tumor. PATIENTS AND METHODS: In a prospective randomized study, 311 melanoma patients with a Breslow thickness > or = 1.5 mm were assigned to either adjuvant IFNalpha2a treatment (n = 154) or observation (n = 157) after excision of the primary tumor. IFNalpha2a was given daily at a dose of 3 mIU subcutaneously (s.c.) for 3 weeks (induction phase), after which a dose of 3 mIU s.c. three times per week was given over 1 year (maintenance phase). RESULTS: Prolonged disease-free survival was observed in patients treated with IFNalpha2a versus those who underwent surgery alone. This difference was significant (P = .02) for all patients enrolled onto the study (intention-to-treat analysis) at a mean observation time of 41 months. Subgroup analysis showed that Breslow tumor thickness had no influence on treatment results in the groups of patients investigated. CONCLUSION: Adjuvant IFNalpha2a treatment diminishes the occurrence of metastases and thus prolongs disease-free survival in resected primary stage II cutaneous melanoma patients.
Adjuvants, Immunologic↗