Sociological and cultural factors affecting consent for organ donation.
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Attitude to Health↗
Biomedical subjects
D D Lewis
Publications and source records attributed to D D Lewis.
Comminuted supracondylar humeral fractures repaired with a modified type I external skeletal fixator construct.
Highly comminuted supracondylar humeral fractures were stabilised in six large-breed dogs with a modified type I external fixator using a craniomedial acrylic connecting column and an intramedullary pin which was incorporated into the connecting frame. This construct provided sufficient stability to allow satisfactory bone healing in five of the six dogs, while premature removal of the intramedullary pin and external fixator resulted in subsequent refracture of the humerus in the remaining dog. Limb function at the time of final assessment was considered excellent in two dogs, good in three dogs and poor in one dog. The craniomedial acrylic connecting column simplified application of this modified type I(a) configuration to the humerus by reducing the number of clamps required; the acrylic column also facilitated contouring of the craniomedial connecting column to the brachium and was readily extended proximally to engage the intramedullary pin. In addition, the acrylic connecting column allowed placement of intramedullary pins of varying diameter.
Animals↗
Non-heart-beating donors: a case study in procurement.
To help meet the increasing need for transplantable organs, especially kidneys, organ procurement organizations are recovering organs from non-heart-beating patients. This article outlines the successful recovery and transplantation of kidneys from such a donor. Consent issues and historical background are also discussed.
Accidents, Traffic↗
Effect of radiographic positioning on interpretation of cubital joint congruity in dogs.
OBJECTIVE: To ascertain effects of x-ray beam centering and limb position on apparent congruity of a normal cubital joint (elbow). ANIMALS: 6 skeletally mature male Treeing Walker Coonhounds without physical, radiographic, or gross evidence of elbow abnormalities. PROCEDURE: Relative movement among humerus, radius, and ulna and measured joint space width on mediolateral and craniocaudal radiographic views was compared, using various x-ray beam centering and limb positions. RESULTS: Highest agreement and greatest certainty on subjective determination of congruity was for the flexed 90 degrees mediolateral radiographic view with the x-ray beam centered on the elbow. Distortion artifact of the proximal ulnar measurements was significant when the x-ray beam was centered on the midpoint of the radius. On the mediolateral view, the humeroradial joint space became significantly wide when the elbow was flexed. On the craniocaudal view, maximal humeroradial joint space width was obtained when the x-ray beam bisected the angle of the joint or was angled +30 degrees toward the humerus. CONCLUSIONS: Artifact distortion of joint width affected objective and subjective assessment of elbow congruity when the limb was placed in extreme flexion or extension or when the x-ray beam was not centered over the area of interest. Optimal visualization of the humeroradial joint space on the craniocaudal view was achieved when the x-ray beam bisected the angle of the elbow or was slightly angled toward the humerus. CLINICAL RELEVANCE: Elbow congruity was best assessed on the flexed 90 degrees lateral radiographic view with the x-ray beam centered on the joint.
Animals↗
Mechanical comparison of materials used for extra-capsular stabilisation of the stifle joint in dogs.
OBJECTIVE: The mechanical properties of three materials (No. 2 polypropylene, No. 5 polybutilate-coated multifilament polyester and 18, 27 and 36 kg test monofilament nylon leader material) commonly used for extra-capsular stabilisation of the stifle in dogs with cranial cruciate ligament insufficiency were determined. The ability of No. 5 polybutilate-coated multifilament polyester and 36 kg test monofilament nylon leader material, when placed as extra-capsular sutures, to mitigate cranial drawer was evaluated in hindlimbs of cadavers. DESIGN: An in vitro mechanical study. ANIMALS: Seven pairs of hindlimbs harvested from adult greyhound dogs recently euthanased for other reasons. PROCEDURE: Samples of each material, including samples of 27 kg test leader material that had been sterilised by one of three methods (ethylene oxide, one or five cycles in an auto-clave), were loaded to determine tensile and stress relaxation properties. The effect of cyclic loading on a No. 5 polybutilate-coated multifilament polyester and 36 kg test leader material was also determined. Using the harvested hindlimbs, cranial drawer was measured before and after transection of the cranial cruciate ligament and on the first and twelfth cycle following extra-capsular stabilisation with either No. 5 polybutilate-coated multifilament suture or 36 kg test leader material. RESULTS: Leader material was found to have the most suitable mechanical characteristics for use as extracapsular stabilisation of the cranial cruciate ligament deficient stifle. Of the sterilisation methods, ethylene oxide was found to have the least detrimental effects on the handling and material characteristics of the leader material. Stifles stabilised with 36 kg test leader material had significantly less drawer than those stabilised with No. 5 polybutilate-coated multifilament polyester suture. CLINICAL IMPLICATIONS: Monofilament nylon leader material would appear to have suitable mechanical properties for extra-capsular stabilisation of the cranial cruciate ligament deficient stifle. If possible the material should be sterilised using ethylene oxide.
Animals↗
Organ recovery following childbirth by a brain-dead mother: a case report.
Little information is available in the medical and nursing literature concerning organ recovery from brain-dead, pregnant individuals. Many healthcare professionals might rule out such patients as potential donors, especially if childbirth is a possibility. This article presents an actual case study in which the birth of a healthy infant and recovery of organs from the mother were successful. It also reviews the available literature and discusses factors related to organ placement.
Adult↗
Organ recovery from an 84-year-old donor: a case study.
To help meet the increasing need for transplantable organs, organ procurement organizations should consider evaluating all brain-dead patients, regardless of the upper age limit. This article outlines the successful recovery and transplantation of the liver of an 84-year-old donor. Organ placement and financial issues involved with the case are also discussed.
Aged↗
Evaluation of shelf arthroplasty as a treatment for hip dysplasia in dogs.
OBJECTIVE: To evaluate effects of shelf arthroplasty on coxofemoral joint laxity and progression of degenerative joint disease in young dogs with hip dysplasia. DESIGN: Prospective, controlled study. ANIMALS: 10 dogs between 10 and 24 months old and weighing between 20 and 27 kg. All dogs had bilateral coxofemoral joint laxity (i.e., an Ortolani's sign). PROCEDURE: In all dogs, shelf arthroplasty was performed on the right coxofemoral joints, and a sham procedure was performed on the left. Dogs were evaluated before and after surgery by means of lameness assessment, coxofemoral joint palpation and goniometry, thigh circumference measurement, and radiography. RESULTS: There were no significant changes in coxofemoral joint mobility, range of motion, joint laxity, degree of degenerative joint disease, or thigh circumference during the study. A greater amount of periacetabular bone formed on the right side than on the left side; however, dogs did not develop large bony shelves, and the amount of periarticular bone decreased over time. The polymer implants remained in their original position and were encapsulated by fibrous tissue. There was no histologic evidence of osteoconduction by the implants. CLINICAL IMPLICATIONS: The polymer implants used in this procedure do not appear to be osteoconductive. Shelf arthroplasty was associated with minimal morbidity and was not associated with serious adverse sequelae in this study, but the procedure did not alter the progression of hip dysplasia in these dogs. We cannot advocate shelf arthroplasty using this polymer as a treatment for dogs with hip dysplasia.
Animals↗
Factors influencing organ placement efforts in donors with brain tumors.
A 3-year retrospective review of brain tumor cases was performed to determine factors that influence organ procurement in light of the increase in references in transplant literature to the hazards of transplanting organs from donors with brain tumors. A 3-year review of cases in which organ procurement efforts occurred were evaluated. Of 314 cases resulting from this review, organ procurement efforts yielded 10 patients with a diagnosis of brain tumor. Of those 10 cases, seven progressed to organ donation, with at least one organ per patient recovered. Manipulation of brain tumors or manipulation along with tissue diagnosis does not seem to hinder procurement of organs. Without tissue diagnosis, the ability of the organ procurement organization to place organs decreases significantly.
Brain Neoplasms↗
Thirty hours from referral to cross-clamp: a case study in organ procurement.
Families of potential organ donors might have requests that prolong the donation process. Organ procurement organizations therefore should be sensitive to these issues, or risk losing potential donors. This study focused on a case that in duration surpassed 30 hours from initial referral to cross-clamp in the operating room. This article examines the legal, family, and management issues involved in such a case.
Adolescent↗
Management of penetrating joint injuries.
A classification scheme for penetrating joint injuries is presented. Diagnostic techniques and treatment recommendations for managing penetrating joint injuries in small animals are described. Techniques used in human and equine patients are discussed for comparison.
Animals↗
Distant abdominal and thoracic pedicle skin flaps for treatment of distal limb skin defects.
The treatment of large skin defects of the distal limbs of dogs and cats can be difficult due to the lack of skin available for primary wound closure or the creation of local skin flaps. Distant pedicle skin flaps provide an acceptable alternative for wound closure with full thickness skin and provide a cosmetic result. Fourteen animals (10 dogs and four cats) that had distant pedicle skin flaps are reviewed. The technique allowed 100 per cent wound coverage in 10 of 14 animals and greater than 95 per cent skin flap survival occurred in 12 to 14 animals. complications associated with the procedure were most commonly wound infection and partial suture line dehiscence, however these did not detract from the final outcome. Flap release was in one or two stages, however the outcomes did not appear to be affected by the release protocol.
Animals↗
Effect of deferoxamine and hyperbaric oxygen on free, autogenous, full-thickness skin grafts in dogs.
Free, autogenous, full-thickness skin grafts were applied to 10 dogs; 5 dogs were given an iron chelator, deferoxamine-10% hydroxyethyl pentafraction starch (DEF-HES; 50 mg/kg of body weight, IV), and 5 dogs were given an equal volume of 10% hydroxyethyl pentafraction starch (HES) in 0.9% saline solution (5 ml/kg, IV). All dogs (DEF-HES/HBO- and HES/HBO-treated) were exposed to 60 minutes of hyperbaric oxygen (HBO) at 2 atmospheres absolute pressure twice daily for 10 days, beginning the day of surgery. The percentage of viable graft on day 10 was lower in HES/HBO-treated dogs (mean +/- SD, 13.3 +/- 21.3%; median, 3.0%) than in DEF-HES/HBO-treated dogs (64.7 +/- 39.2%; 88.3%; P = 0.095, Mann-Whitney two-tailed test). There was a positive correlation between percentage of viable graft (on day 10) and percentage of haired skin on the graft site (on day 28) for all dogs (r = 0.91) and for HES/HBO-treated dogs (r = 0.97). The DEF-HES/HBO-treated dogs had less consistent correlation (r = 0.67). Perivascular aggregates of foamy cells were observed in the superficial and reticular portions of the dermis and in the subcutaneous tissue on both surfaces of the panniculus muscle in the graft sites of DEF-HES/HBO-treated dogs. These cells were also observed in the dermis, but not subcutaneous tissue of the control skin sections, and in some viscera of DEF-HES/HBO-treated dogs. Deferoxamine appears to attenuate the detrimental effect of HBO and HES on survival of free skin grafts.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
What is your diagnosis? Radiographic diagnosis--osteochondral fragmentation of the patella.
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Animals↗
Enteroplication for the prevention of intussusception recurrence in dogs: 31 cases (1978-1992).
Medical records of 31 dogs that had undergone surgery for correction of intussusception during a 14-year period were reviewed. Enteroplication was performed on 9 dogs during the initial surgery, and intussusception did not recur in any of these dogs. Intussusceptions recurred in 6 of 22 dogs without enteroplication. Five of these dogs had undergone resection of the primary lesion and anastomosis and 1 dog had undergone manual reduction of the intussusception. Intussusceptions recurred proximal to the initial lesion in 4 dogs, and at the same site in 2 dogs. Enteroplication was performed in 4 dogs following surgical correction of recurrence of an intussusception, and further recurrences were not seen in any of these dogs. Enteroplication did not cause any apparent adverse effects and decreased the probability of recurrence of intussusception in these dogs.
Anastomosis, Surgical↗
Effect of intravenous administration of hydroxyethyl-starch-deferoxamine on oxygen-derived free radical generation in cancellous bone specimens obtained from dogs.
The ability of IV administered hydroxyethyl-starch-deferoxamine to attenuate radical production in freshly procured cancellous bone specimens was investigated, using spin-trapping and electron spin resonance (ESR) techniques. A core cancellous bone specimen 10 mm long and 5.6 mm in diameter was obtained, using aseptic technique, from the proximal portion of the humerus of 30 adult mixed-breed dogs. After procurement of the initial bone specimen, 10 dogs received a 10% solution of hydroxyethyl-starch-deferoxamine in 0.9% NaCl (50 mg/kg of body weight, IV), 10 dogs received an equivalent volume (5 ml/kg, IV) of a 10% solution of hydroxyethyl-starch in 0.9% NaCl, and 10 dogs received 0.9% saline solution (5 ml/kg, IV). A second core cancellous bone specimen was obtained from the contralateral humerus of each dog 45 minutes after treatment. All specimens were individually incubated in the spin trap alpha-phenyl-N-tert-butylnitrone in Eagle's minimum essential medium, at 26 C for 45 minutes, then were frozen at -20 C until they were prepared for analysis by ESR spectroscopy. Each specimen was thawed, homogenized, and extracted in a low-dielectric organic solvent prior to obtaining an ESR spectrum, which was analyzed for hyperfine splitting constants for radical identification. Each first-derivative spectrum was digitally double-integrated to obtain an area; these areas were used to compare intensities of the spin adducts. Difference in the area obtained before and after treatment for each dog was expressed as a ratio of that dog's pretreatment area ([pretreatment - posttreatment])/pretreatment).(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Investigation of oxygen-derived free radical generation in cancellous bone specimens obtained from dogs.
Generation of free radicals and the ability of various antioxidants to attenuate radical production in freshly procured cancellous bone specimens was investigated, using spin-trapping and electron spin resonance (ESR) techniques. Seven core cancellous bone specimens, 10 mm long and 7.9 mm in diameter, were obtained using aseptic technique, from the proximal portion of the humerus of 9 adult mixed-breed dogs. One core cancellous bone specimen from each dog was incubated in spin trap alpha-phenyl-N-tert-butylnitrone in Eagle's minimum essential medium and served as a control. The other 6 specimens from each dog were incubated in alpha-phenyl-N-tert-butylnitrone/Eagle's minimum essential medium plus 1 of the following antioxidants: superoxide dismutase, catalase, superoxide dismutase/catalase, indomethacin, allopurinol, or deferoxamine mesylate. All specimens were incubated at 26 C for 90 minutes, then frozen at -20 C until they were prepared for analysis by ESR spectroscopy. Each specimen was thawed, homogenized, and extracted in a low-dielectric organic solvent prior to obtaining an ESR spectrum which was analyzed for hyperfine splitting constants to identify radicals. Each first-derivative spectrum was digitally double-integrated to obtain an area: these areas were used to compare intensities of the spin. For each treatment group, the areas from the treated specimens were compared with the areas from the control specimens, using a paired t-test. Significance was accepted at P < or = 0.05. Spin adducts were detected in all cancellous bone specimens. Specimens incubated in deferoxamine (P = 0.0017) and superoxide dismutase/catalase (P = 0.0452) had significantly smaller areas than did control specimens.(ABSTRACT TRUNCATED AT 250 WORDS)
Allopurinol↗
Fetal alcohol syndrome.
The most notable features of fetal alcohol syndrome involve the face and eyes, and include microcephaly, short palpebral fissures, an underdeveloped philtrum and a thin upper lip. Evidence of intrauterine or postnatal growth retardation, mental retardation or other neurologic abnormalities, and at least two of the typical facial features are necessary to make the diagnosis. Newborns with the syndrome may be irritable, with hypotonia, severe tremors and withdrawal symptoms. Mild mental retardation, the most common and serious deficit, and a variety of other anomalies may accompany fetal alcohol syndrome. Sensory deficits include optic nerve hypoplasia, poor visual acuity, hearing loss, and receptive and expressive language delays. Atrial and ventricular septal defects, as well as renal hypoplasia, bladder diverticula and other genitourinary tract abnormalities, may occur. Complete abstinence during pregnancy is recommended, since alcohol consumption in each trimester has been associated with abnormalities, and the lowest innocuous dose of alcohol is not known.
Diagnosis, Differential↗