Serum level of VEGF-D in patients with primary lymphedema

Recent studies have indicated that vascular endothelial growth factor-D (VEGF-D) stimulates lymphangiogenesis in humans. Furthermore, mutations of vascular endothelial growth factor receptor 3 (VEGFR-3) have been observed in families with hereditary lymphedema. The lack of stimulation of lymphangiogenesis could lead to production of even more VEGF-D to obtain stimulation of lymphangiogenesis resulting in a high serum level of VEGF-D. The aim of the present study was to compare the serum level of VEGF-D in patients with primary lymphedema with healthy controls. In a prospective study, the serum level of VEGF-D was determined by a solid phase ELISA in patients with primary lymphedema and compared with healthy controls. In the group of patients with primary lymphedema the serum level of VEGF-D was significantly higher compared with controls (p=0.0047). The increased levels of VEGF-D observed in the present study suggest that primary lymphedema may be based on defective stimulation of VEGFR-3.

Temozolomide and interferon alpha 2b in metastatic melanoma stage IV

BACKGROUND

A multicentre, centrally randomized, open-labelled study with temozolomide and interferon (IFN)-alpha 2b was carried out to study the therapeutic effect in patients with metastatic melanoma stage IV.

OBJECTIVES

The response rate, efficacy, side-effects, reasons for discontinuation of therapy and survival rate of 47 patients treated with temozolomide in combination with two different dosing regimens of IFN-alpha 2b were documented.

PATIENTS/METHODS

Twenty-nine male and 18 female patients (mean age 57.6 years, range 34-74) were centrally randomized to two different arms: 20 patients received a treatment schedule with temozolomide 150 mg m(-2) on days 1-5 orally every 28 days in combination with IFN-alpha 2b 10 MIU m(-2) every other day and 27 patients received temozolomide 150 mg m(-2) on days 1-5 every 28 days in combination with IFN-alpha 2b in a fixed dose of 10 MIU every other day.

RESULTS

We observed an overall response rate of 27.6% comprising five complete remissions (10.6%: one patient group A, four patients group B), in two of these five patients at the last follow-up in the study (4.3%, both in group B); and eight partial remissions (17%: six patients in group A, two patients in group B), in three of these eight patients at the last follow-up in the study (6.4%, two patients in group A, one patient in group B). Three patients showed stable disease (6.4%: one patient in group A, two patients in group B). Mean survival was 14.5 months [95% confidence interval (CI) 10-19] with no significant differences between treatment groups. However, there was a significant correlation with response after three cycles (log rank test, P < 0.03). Within the 32 patients who completed at least three cycles of therapy, seven patients (three in group A and four in group B) with a partial or complete response showed a significantly better mean survival of 30.6 months (95% CI 19.1-42) compared with 25 patients who did not respond (13.7 months 95% CI 9.2-18.3). In total, patients with at least one complete remission showed the longest survival (37.1 months 95% CI 26.3-47.9), followed by patients with at least one partial response (17.4 95% CI 10.9-23.9). Major side-effects of the treatment were nausea, vomiting, headache, leucopenia, thrombopenia, elevation of liver function parameters and neurological symptoms. In five patients, the side-effects led to a discontinuation of treatment: neurological symptoms (two patients), sepsis (one patient), brain haemorrhage (one patient) and exanthema (one patient). There were no treatment-related deaths.

CONCLUSIONS

The combination of temozolomide and IFN-alpha 2b can easily be administered and shows tolerable toxicity. When an objective response occurs after three cycles, it indicates a significant survival advantage.

Improving the quality of mental health services in Personal Medical Services pilots: a longitudinal qualitative study

BACKGROUND

A series of government initiatives in the UK have included strategies to improve the quality of services received by patients, including fundholding, the development of National Service Frameworks, clinical governance, and Personal Medical Services (PMS). PMS represents a new contractual arrangement between government and general practitioners (GPs) which provides new investment in return for more detailed specification of processes and outcomes of care.

OBJECTIVES

To evaluate the effects of PMS on the quality of primary mental health care between 1998 and 2001.

DESIGN

Multiple longitudinal case studies. Semi-structured interviews with key staff within practices (GPs, nurses, practice managers) and outside (health authority and primary care group/trust managers).

SAMPLE

Six first wave PMS sites which had specifically planned to improve their mental health care.

RESULTS

Improvements in mental health care were found in some PMS practices and not in others. Five mechanisms associated with successful quality improvement in mental health were identified: clear goals, effective teamwork within the practice, routine use of protocols and audits, additional resources, and effective collaboration with community and secondary care. Sites where these factors were not present struggled to meet their objectives.

CONCLUSION

The five mechanisms which resulted in improved mental health care were facilitated by the new contractual arrangements in PMS. The new contracts were not a necessary part of these changes, but they enabled sites with an identified interest and motivation to make the changes. The contractual changes were not in themselves sufficient to improve care.

An In vitro Study on Spontaneous Cervical Contractility in the Cow During Oestrus and Diestrus

Cervical smooth muscle specimens were collected from slaughtered cows in oestrus and diestrus. Longitudinal and circular specimens were mounted in organ baths and after equilibration time and 2 g pre-load, their physiologic isometric contractility was recorded for 2.5 h. Area under the curve (AUC), maximal amplitude (Amax), mean amplitude (Amen) and minimal amplitude (Amin) were studied. Differences between cycle phases, between muscle layers and over the recorded time periods were statistically evaluated using linear mixed-effect models. In the cow, physiologic contractility of the cervix decreased significantly over time for all variables evaluated (time as covariate on a continuous scale). Furthermore, for Amax, there was a tendency for an influence of muscle layer (longitudinal > circular). Contractility was not influenced by cycle phases.

Effect of endotoxins on contractility of smooth muscle preparations from the bovine abomasal antrum

The effects of endotoxin (ET) on spontaneous contractility and of carbachol- and alpha-methyl-5-hydroxytryptamine-(alpha-M-5-HT; 5-HT2 receptor agonist) induced contractions of smooth muscle preparations from the bovine abomasal antrum were investigated in vitro. Preparations from the abomasal antrum of freshly slaughtered healthy dairy cows were cut parallel to the longitudinal and circular fibres, suspended in isolated organ baths, and contractility was recorded and analyzed, using digitalized data. The traits maximum amplitude, time till maximum amplitude, frequency, basal tone, and area under curve were calculated. The contractile effect of Carbachol (CH) was concentration dependent. Repeated administration of CH (3.75 x 10(-6) M), each time interrupted by flushing of the organ baths, did not reveal any significant effect on contractility traits of CH-induced contractions. Endotoxin (10 micrograms/ml; lipopolysaccharide from E. coli, O26:B6) significantly reduced some of the spontaneously occurring contractility traits and of carbachol-(3.75 x 10(-6) M) and alpha-M-5-HT-induced (2.14 x 10(-5) M) contractions. The effects of higher and lower concentrations of ET occurred less consistently. The inhibitory effect of endotoxin was more pronounced after 6 hours as compared to 2 hours of incubation. The results of the present study (i) support the hypothesis of a possible role of endotoxin in reducing motility of the abomasum during the development of spontaneous abomasal displacement in dairy cows, and (ii) may serve as the basis for the development of an in vitro model of abomasal displacement with endotoxemia for future studies on the effect of motility modulating drugs.

In vitro effects of cisapride, metoclopramide and bethanechol on smooth muscle preparations from abomasal antrum and duodenum of dairy cows

The objective of this study was to investigate the effects of cisapride (CIS), metoclopramide (MET) and bethanechol (BET) on contractility parameters from smooth muscle preparations of the abomasal antrum and proximal duodenum of cows. Smooth muscle preparations were harvested shortly post-mortem from 42 healthy dairy cows, and concentration-response curves were performed by cumulative application of the drugs. Cisapride and MET did not have any significant effect on the contractility parameters studied, while BET induced a significant, concentration-dependent increase in basal tone (BT), mean amplitude (Amean), and area under the curve (AUC) in smooth muscle preparations from the abomasal antrum, but not from the duodenum. The effect of BET on BT was more pronounced in specimens with longitudinal orientation while the maximal obtainable effect (Vm) in Amean was more pronounced in circular-oriented preparations. Atropine (1 x 10-5 m) significantly inhibited the effect of BET, whereas pre-incubation with hexamethonium or tetrodotoxin (TTX) had no effect, suggesting that the effect was mediated by cholinergic receptors on the smooth muscle. The results may be relevant to diseases or disorders associated with gastric emptying and gastric hypomotility. Further investigations are warranted to investigate the potential ability of BET to enhance abomasal emptying of adult dairy cows.

Effect of prostaglandin E2, DL-cloprostenol, and prostaglandin E2 in combination with D-cloprostenol on uterine motility during diestrus in experimental cows

Prostaglandin F(2alpha) is used in dairy herd management because of its luteolytic properties and for its direct effect on the myometrium in cows diagnosed with endometritis. Prostaglandin E(2) has a contractile effect on the bovine uterus. In human medicine, prostaglandin E(2) is routinely used to maintain labor and to ripen the cervix. We hypothesized, that a combination of prostaglandin F(2alpha) and prostaglandin E(2) would provoke a long-lasting increase in intrauterine pressure (IUP) and uterine motility as compared to either prostaglandin group. Intrauterine pressure was recorded during the diestrus of eight lactating dairy cows using a transcervically placed intraluminal pressure microtransducer. After recording of physiologic uterine motility for 30min, prostaglandins (DL-cloprostenol, PGE(2), PGE(2) in combination with D-cloprostenol) or placebo were administered, followed by a 2h recording period. Significant differences were found for the area under the curve, the mean amplitude and the intrauterine pressure, whereas the number of pressure waves did not differ significantly among treatments. Peak values for area under the curve and mean amplitude were found during the first 15min for the combination of PGE(2) and D-cloprostenol. During the last 15min of the recording session, area under the curve and mean amplitude were increased only for the combination of PGE(2) and D-cloprostenol as compared to placebo. Although PGF(2alpha) and PGE(2) provoke an increase in intrauterine pressure, only their combination guarantees a significant effect over a 2h recording period.

Modification of spontaneous contractility of smooth muscle preparations from the bovine abomasal antrum by serotonin receptor agonists

The effects of serotonin (5-hydroxytryptamine, 5-HT), a 5-HT2-receptor agonist, alpha-methyl-5-hydroxytryptamine (alpha-M-5-HT) and RS-67506, a 5-HT4 receptor partial agonist, on spontaneous contractility of bovine abomasal smooth muscle preparations were investigated in vitro. Preparations from the abomasal antrum of freshly slaughtered healthy dairy cows were cut parallel to the longitudinal fibres, suspended in isolated organ baths, and concentration-response curves were performed by cumulative application of the 5-HT receptor agonists. Blockade of 5-HT2-induced response was tested with atropine and hexamethonium. Serotonin evoked a significant increase in the area under curve (AUC), whilst the 5-HT2 receptor agonist alpha-M-5-HT significantly increased the AUC and resting tone (RT). RS-67506 induced a significant increase in AUC and RT and a significant decrease in the maximum force. The effect of alpha-M-5-HT was mediated by a muscarinic cholinergic pathway, as the effect of alpha-M-5-HT was inhibited in the presence of atropine but not hexamethonium. It is concluded that 5-HT2 and 5-HT4 receptors are present in the bovine abomasal antrum. Muscarinic receptors are involved in the increase in RT seen after 5-HT2 receptor stimulation.

[Open diagonal fracture of metatarsus III/IV and internal fixation in an alpaca]

This report describes the case of a 15-month-old alpaca stallion with an open fracture of metatarsus (MT) III/IV that occurred during transportation. Despite of a guarded prognosis, the animal was operated on request of the owner. The surgical intervention consisted of meticulous lavage and curettage of the wound and affected bone, precise fracture reduction, internal fixation with a 12-hole broad 3.5 mm DCP and implantation of a gentamicin impregnated collagen sponge. Primary wound healing was evident and the implant was removed at 3 months after the initial intervention. At 14 months after surgery, the stallion did not show any signs of lameness and was used for service.

[The most important local anesthesia in cattle: a review]

Surgical interventions in cattle are frequently performed under local analgesia. Local analgesia may be carried out in the standing animal without or with slight sedation or with the animal in recumbency after deep sedation. Injection of local analgesics is less time consuming than induction and maintenance of general analgesia and is, therefore, frequently used in private veterinary practice. Precise anatomical knowledge of the nerve supply to the area to be operated is a prerequisite for the successful introduction of a local analgesia. The goal of the present review is to summarize nerve supply and indications for surgery in the area of the head, male genital tract, teat and the claws of the hind limb of cattle.

[Delegation of castration of calves and lambs to the livestock owner: internet survey of members of the Swiss Association for Ruminant Medicine]

According to the Swiss Federal law on animal protection and welfare, painful manipulations in animals have to be performed by a veterinarian under local or general anaesthesia, except for some specifically listed surgical interventions (article 65 of the by-law on animal protection). On September 1, 2001, castration of calves and lambs has been deleted from this list of exceptions. Since then, several pressure groups have requested these interventions to be delegated to the producers for economical reasons. The current article describes the results of a web-based survey on this subject, conducted among the members of the Swiss Association of ruminant practitioners (SARP). Two separate questionnaires--one focused on calves and one on lambs--were made available to the members of the SARP for a duration of 3 months as pdf-files on the homepage of the SARP (www.svwasmr.ch). On December 31, 2002, the deadline for submission of the completed questionnaires, the membership of the SARP was constituted of 360 practicing veterinarians. The response rate was 25%. Close to a hundred percents of the responding veterinarians expressed the expectation that the SARP publish guidelines on the castration of calves and lambs. An overwhelming majority refused the delegation of castrations to the producers, and further stated that they were not ready to accept any responsibility for interventions performed by the producers. However, a third of the responding veterinarians judged the expected workload for the castration of lambs to presumably exceed their current capacity. It is concluded from the results of this survey that the board of the SARP should urgently elaborate, discuss, and propose novel and innovative concepts to solve the issue of castration of calves and lambs.

[The effect of a pain medication in bloodless castration of male calves on the concentrated feed intake, weight gain and serum cortisol level]

Since September 2001, castration of male calves in Switzerland is not allowed without anesthesia. The use of rubber rings for this purpose is forbidden. It was the goal of this study to describe the effect of a non-steroidal antiinflammatory drug, administered additionally to sedation and local anesthesia, in clamp-castrated (Burdizzo) calves of 110 to 160 kg of body weight. Plasma fibrinogen concentration, white blood cell count, serum cortisol concentration, scrotal swelling, concentrate intake and weight gain were evaluated. A positive effect after administration of a NSAID was obvious for the serum cortisol concentration, the concentrate intake within the first 3 days after castration and scrotal swelling.

Treatment of temporary upward fixation of the patella in an alpaca by abrasion trochleoplasty and imbrication of the medial retinacular fascia

A two-year-old female alpaca suddenly became lame on its right hindlimb. Eight days later clinical and radiographic examinations showed that the patella had become temporarily fixed within the supratrochlear notch of the femur. Under general anaesthesia an abrasion trochleoplasty followed by fascial imbrication was carried out. After two weeks in supporting slings, the animal put full weight on the leg, and six months after the surgery it showed no signs of lameness or recurrence of the upward fixation.

[Unilateral laparoscopic cryptorchidectomy in a llama]

Cryptorchism is an inherited congenital abnormality characterized by the failure of one or both testes to descend into the scrotum. Diagnosis can be difficult if the retained testicular tissue cannot be localized during clinical examination and the history of the animal is unknown, or if the animal shows persistent male behaviour despite the history of successful previous castration. The present case report describes the history of a cryptorchid Lama and the techniques of general anesthesia and laparoscopic cryptorchidectomy advocated.

An in vitro study on spontaneous myometrial contractility in the cow during estrus and diestrus

Myometrial smooth muscle strips were collected from slaughtered cows in estrus and diestrus. Longitudinal and circular smooth muscle strips were mounted in organ baths and after equilibration time and 2g preload, their physiologic contractility was recorded for 3h. Area under the curve (AUC), mean amplitude (MA) and frequency of contractions (F) were studied. Differences between cycle phases, between muscle layers and over the recorded time period were statistically evaluated. In the cow, physiologic contractility patterns (measured as AUC and MA) of circular versus longitudinal myometrial strips are always different during the 3h recording. Significant differences between estrus versus diestrus are only found for circular layers, but not for longitudinal layers. Significant differences over time are only found for longitudinal layers.

[Castration of male lambs and calves: explanations and comments of art. 65 TSchV]

Since September 1, 2001, castration of male calves and small ruminants in Switzerland is not allowed without anesthesia. The use of rubber rings for that purpose is forbidden. This change of the legislation has been claimed by the Swiss consumers and is aimed to increase the animal welfare. The current paper provides a review of the different techniques of anesthesia and castration that may be advocated in male ruminants. Sedation with xylazine and injection of lidocaine in the area of the base of the scrotum, followed by closed castration with the Burdizzo represents a safe technique for painfree castration of calves and lambs.

Lupus anticoagulant and venous leg ulceration

BACKGROUND

Most leg ulcers occur in patients with venous insufficiency. However, not all patients with venous insufficiency develop leg ulcers. Recent studies have found that factors causing clotting abnormalities, e.g. anticardiolipin antibody (ACA), are associated with leg ulcers. Although lupus anticoagulant, like ACA, belongs to the group of antiphospholipid antibodies, its presence in patients with venous leg ulceration has not been previously reported.

OBJECTIVES

To determine the presence of lupus anticoagulant in patients with venous leg ulceration.

METHODS

We investigated the presence of lupus anticoagulant in 27 patients with venous leg ulcers and compared these data with controls. Lupus anticoagulant was evaluated in all subjects by the Russell's viper venom test.

RESULTS

Of 27 patients with venous leg ulceration, 16 (59%) were shown to have lupus anticoagulant, while only one of 32 controls (3%) was found to have lupus anticoagulant. Thus, lupus anticoagulant was significantly more frequent in patients with venous leg ulcers than in controls (P < 0.001).

CONCLUSIONS

We suggest that lupus anticoagulant could be a hitherto unknown factor contributing to the development of venous leg ulcers.

[Short- and longterm results after surgical treatment of teat stenosis in the region of Fürstenberg's rosette using theloresectoscopy: 15 cases (1999-2000)]

Teat obstructions cause considerable financial loss in dairy industry. Recently, progress in teat surgery was made by the use of minimal invasive surgical instrumentation. The technique of theloresectoscopy as well as short- and long-term results of this surgical intervention are presented in this study. The clinical reports of 15 dairy cows with distal teat obstructions operated with the theloresectoscope between May 1999 and January 2000 at the clinic for ruminants, Department of clinical veterinary medicine, University of Berne were reviewed. Data collected by telephone conversation with the owners included: somatic cell count and milk flow at machine milking during the lactation of surgery (lactation 1), as well as during the lactation following surgery (lactation 2). Eighty-seven percent of the owners reported normal milk flow during lactation 1 and 93% during lactation 2. Considering the fact that only 46.7% of the cows showed negative results in the California mastitis test (CMT) during lactation 1, many owners reported a high somatic cell count being a disadvantage of this surgical technique. Normal (negative) CMT results during lactation 2, however, were reported by 80% of the owners. Isolation of Staphylococcus aureus explained the high somatic cell count in 2 of 15 cases. In conclusion, theloresectoscopy is a valuable minimal invasive surgical technique that can be fully recommended for treatment of distal teat obstructions in dairy cows.

[Mondor phlebitis associated with hepatitis C]

Mondor's disease in association with hepatitis C. We report a case of a 40 years old patient suffering from Mondor's disease. Neither a malignancy nor a disturbance of the clotting system was found. This case is remarkable for the association with hepatitis C.

Fenestration of the abaxial hoof wall and implantation of gentamicin-impregnated collagen sponges for the treatment of septic arthritis of the distal interphalangeal joint in cattle

A novel surgical approach to the distal interphalangeal joint of cattle, through the abaxial hoof wall, for the treatment of septic arthritis is described. In seven cattle a rectangular piece of horn (15 x 40 mm) was excised from the abaxial hoof wall and the joint was lavaged with Ringer's solution. Infected and/or necrotic tissue was removed from the joint and gentamicin-impregnated collagen sponges were introduced. The piece of horn was reattached, a rubber block was glued to the contralateral claw, and a bandage applied. Aftercare consisted of changes of bandage, systemic administration of antimicrobial drugs and box rest. At follow-up, six of the cattle were sound but one cow which had been slaughtered five months after surgery had remained slightly lame.

Triprotic 2,4,6-tris(organoamino)-1,3,5-triazenes as precursors to multi-site triazenate ligands

2,4,6-Tris(2-fluoroanilino)-1,3,5-triazene successively undergoes one-, two- and three-fold deprotonation in the presence of BunLi; the dilithiated triazenate exists as the dimeric complex (thf)6Li4[(RN)2(RNH)C3N3]2 in the solid state (R = 2-F-C6H4) featuring bidentate Nendo-C-Nexo chelation sites.