Abstract P2-11-03: Not presented

This abstract was not presented at the symposium.

Sheep from low-methane-yield selection lines created on alfalfa pellets also have lower methane yield under pastoral farming conditions

Selection lines of sheep with low and high CH yield (g/kg DMI; CH/DMI) are being developed on the basis of feeding pelleted alfalfa hay at 2.0 times maintenance ME requirements in respiration chambers, but their divergence under predominant grazing conditions, as in New Zealand, is not known. The objectives of this study were to determine CH emissions and rumen fermentation characteristics in sheep from low and high CH/DMI selection lines while grazing pasture. Two grazing experiments were conducted with 42 selection line ewes in March 2013 (Exp. 1) and 98 selection line progeny ewe hoggets in October/November 2014 (Exp. 2), with CH emissions estimated by the SF tracer technique and DMI estimated by titanium oxide in combination with natural long-chain -alkanes. Total daily CH production (g/d) was similar between high and low CH/DMI selection line sheep in Exp. 1 and lower for low CH/DMI progeny compared with high CH/DMI progeny in Exp. 2 ( < 0.05). The CH/DMI tended to be 20% lower for low CH/DMI line sheep compared with high CH/DMI selection line sheep in Exp. 1 ( < 0.10) and was 15% lower for the low CH/DMI line in Exp. 2 ( < 0.01). Total VFA concentration and concentrations (m) of acetate, butyrate, and isobutyrate plus isovalerate were lower ( < 0.05) for low CH/DMI line sheep compared with high CH/DMI selection line sheep in both experiments. The current study indicates that differences in CH/DMI and VFA concentrations in selection line sheep, previously established on alfalfa pellets, are also present to a similar magnitude when grazing pasture.

Assessment of the impact of flares in ankylosing spondylitis disease activity using the Flare Illustration

OBJECTIVES

Many AS patients report periods of perceived higher disease activity (flares). This pilot study aims to document disease activity patterns reported by AS patients and examine associations with disease-specific health status measures.

METHODS

Consecutive AS patients (n = 114) were asked whether they experience flares, and if they experience symptoms of AS between flares. They were shown the Flare Illustration of disease patterns over time and asked to select the pattern that best described their disease (i) since symptom onset and (ii) in the past year. Associations between reported disease pattern and disease activity (Bath AS Disease Activity Index, BASDAI); functional impairment (Bath AS Functional Index, BASFI); AS Quality of Life (ASQoL); Back Pain (Nocturnal and Overall) and demographic features were assessed in a subsample (n = 83) (statistical significance defined at P <or= 0.05).

RESULTS

Since disease onset 108/113 patients (96%) reported flares, and 82/99 (83%) reported symptoms of AS between flares. Flares typically lasted days or weeks. When patients were asked to characterize their disease pattern using the Flare Illustration, patterns with constant symptoms predominated (>70% of patients) and patterns with constant symptoms since onset (vs intermittent symptoms) were associated with worse health status (ASQoL: P = 0.007; BASDAI: P = 0.029; BASFI: P = 0.013, overall back pain: P = 0.025).

CONCLUSIONS

Almost all AS patients report flares in disease activity: 70-80% report constant symptoms with single/repeated flares, while 20-30% report flares with no intermittent symptoms. The former is associated with a significantly poorer health status. These findings will be validated in a prospective study.

Rare presentation of laryngeal neuroma in a patient with multiple endocrine neoplasia type two B

Objective:

We present a rare case of laryngeal mucosal neuroma, and its management, in a patient with multiple endocrine neoplasia type 2 B.

Method:

We present a case report and a review of the world literature concerning laryngeal mucosal neuroma and its association with multiple endocrine neoplasia type 2 B.

Case report:

An 11-year-old girl was diagnosed with multiple endocrine neoplasia type 2 B on the basis of clinical presentation and genetic testing. Several years later, whilst undergoing general anaesthesia for routine dental treatment, the anaesthetic team were concerned by masses on the patient's vocal folds, which they felt could compromise her airway. The ENT team were informed of the situation and an urgent microlaryngoscopy was performed. Biopsies taken at the time were reported as showing benign mucosal neuromas. A few months later, the patient presented with acute stridor, and flexible nasal endoscopy revealed recurrence. This episode settled without surgery.

Conclusion:

Multiple endocrine neoplasia syndromes are inherited autosomal cancer syndromes. Laryngeal mucosal neuroma can manifest as potentially airway compromising lesions in patients with multiple endocrine neoplasia type 2 B. Although apparently rare, we feel this case highlights the need for vigilance and prompt recognition of this treatable condition.

Post-operative pain in tonsillectomy: bipolar electrodissection technique vs dissection ligation technique. A double-blind randomized prospective trial

The two commonly employed methods for tonsillectomy at present are electrodissection and ligature dissection. This study was carried out on 70 patients as a randomized prospective double blind trial to compare the post-operative morbidity of these methods with special reference to pain. The post-operative pain appears to be much less for the ligation dissection technique compared to the electrodissection method except during the first post-operative day. Irrespective of the technique employed for tonsillectomy, the worst pain was experienced on the fifth and sixth post-operative day by almost all of the patients.

Manual dexterity and successful hearing aid use

Fine dexterity of the hand might be expected to correlate with the successful use of a hearing aid. In this study, the manual dexterity of 30 individuals between 65 and 85 years using a hearing aid was tested by the Purdue pegboard test and the result was compared to the benefit obtained from the use of a hearing aid assessed by a questionnaire. Of the 30 individuals included in this study 16 were wearing a 'behind the ear' type of hearing aid and the rest had an 'in the ear' type of hearing aid. A comparison is made between the two types of heariing aids. The results demonstrate a correlation between manual dexterity and successful use of a hearing aid when all the 30 individuals were considered as a single group. However, no such correlation was found for 'in the ear' group when they were analysed separately.

First branchial groove anomaly

First branchial groove anomalies are very rare. We report a case of a first branchial groove anomaly presented as an infected cyst in an 11-month-old child. Management of such lesions is complicated because of their close association with the facial nerve. Surgical management must include identification and protection of the facial nerve. Embryology and facial nerve disposition in relation to the anomaly are reviewed.

Testing the stress-response sequence model in paediatric oncology nursing

The causes and intensity of role-related stress experienced by paediatric oncology nurses, the nurses' ability to respond to the stressors, and the professional and personal consequences of those stressors for the nurses are issues of concern for administrators and staff. The concern evolves from the anticipated relationships among stressors, the ability to cope with role-related stressors, and the expected negative outcomes such as resignation. However, the relationships among these components have not been previously measured concurrently in paediatric oncology nurses. The primary purpose of this study was to test the complete stress-response sequence model in a sample of paediatric oncology nurses by obtaining concurrent measures of the model's individual components: nurses' stressors, reactions, mediators, and consequences. A total of 126 nurses completed six questionnaires (Stressor Scale for Paediatric Oncology Nurses, Perceived Stress Scale, Measure of Job Satisfaction, Organized Commitment Questionnaire, Group Cohesion Scale, and Intent to Leave) and a demographic sheet. The majority of participating nurses were married, worked full-time and had worked 5 or more years in oncology. Qualitative data were analysed using a semantic content analysis technique. Relationships among the components of the model were examined using a two-stage least squares technique. The components were only weakly associated and unable to explain significant variation in each other. The combined qualitative and quantitative data indicate that an important explanatory variable - role-related meaning - is missing in the content model.

In vitro uptake and elimination of isoflurane by different membrane oxygenators

OBJECTIVE

This study was designed to investigate the effect of membrane oxygenator design and composition on the uptake and elimination of isoflurane.

DESIGN

Prospective, in vitro laboratory study.

SETTING

Bioengineering laboratory.

PARTICIPANTS

Three types of membrane oxygenator were tested: the SM-35 (polydimethylsiloxane in sheet form), the CML (polypropylene in sheet form), and the SAFE II (polypropylene in hollow-fiber form). The oxygenators were incorporated into a standard cardiopulmonary bypass circuit.

INTERVENTIONS

Isoflurane was added to the oxygenator input gas and measured in exhaust gas and in (bovine) blood leaving the oxygenator at 1, 2, 3, 5, 7, 10, 15, and 20 minutes. The isoflurane vaporizer was then turned off, and samples were obtained at the same time intervals. The experiment was performed at 28 degrees C and 37 degrees C.

MEASUREMENTS AND MAIN RESULTS

Uptake and elimination of isoflurane were slower via the SM-35 compared with the CML and the SAFE II (p < 0.01).

CONCLUSIONS

If isoflurane is administered during cardiopulmonary bypass, knowledge of the influence of oxygenator membrane composition on its pharmacokinetics is essential if patient awareness and unexpected cardiovascular depression are to be avoided.

The limited role of pneumolysin in the pathogenesis of pneumococcal meningitis

The aim of this study was to determine the role of pneumolysin, an intracellular toxin of Streptococcus pneumoniae, in the pathogenesis of pneumococcal meningitis. Recombinant pneumolysin (1 microgram), when injected intracisternally into rabbits, resulted in a brisk inflammatory response. However, a pneumolysin-deficient strain of S. pneumoniae caused meningeal inflammation in rabbits indistinguishable from that induced by the parent pneumolysin-producing strain. Furthermore, similar enhancement of meningeal inflammation occurred after ampicillin therapy in animals infected with either the parent strain or the pneumolysin-deficient mutant. These results suggest that although pneumolysin can stimulate the inflammatory cascade in the central nervous system, it is not necessary for the pathogenesis of meningeal inflammation nor does it play a role in postantibiotic enhancement of meningeal inflammation.

Caring for the patient with peristomal pyoderma gangrenosum

Pyoderma gangrenosum is an ulcerating skin condition associated with inflammatory bowel disease and other diseases. During and 18-month period beginning in the fall of 1991, seven patients were followed up for pyoderma gangrenosum. Three of these cases, with assessment and treatment plans, are presented. A discussion of treatment principles for managing pyoderma gangrenosum follows.

Evaluation of antimicrobial regimens for treatment of experimental penicillin- and cephalosporin-resistant pneumococcal meningitis

The most appropriate therapy for meningitis caused by Streptococcus pneumoniae strains resistant to the extended-spectrum cephalosporins is unknown. We evaluated ceftriaxone, vancomycin, and rifampin alone and in different combinations and meropenem, cefpirome, and clinafloxacin alone in the rabbit meningitis model. Meningitis was induced in rabbits by intracisternal inoculation of one of two pneumococcal strains isolated from infants with meningitis (ceftriaxone MICs, 4 and 1 microgram/ml, respectively). Two doses, 5 h apart, of each antibiotic were given intravenously (except that ceftriaxone was given as one dose). Cerebrospinal fluid bacterial concentrations were measured at 0, 5, 10, and 24 h after therapy was started. Clinafloxacin was the most active single agent against both strains. Against the more resistant strain, ceftriaxone or meropenem alone was ineffective. The combination of vancomycin and ceftriaxone was synergistic, suggesting that this combination might be effective for initial empiric therapy of pneumococcal meningitis until results of susceptibility studies are available.

Timing of peak pressor response following endotracheal intubation

The study was designed to measure the timing of the peak cardiovascular response following laryngoscopy and endotracheal intubation. Thirty patients ASA 1 or 2 were studied, with arterial pressure being continuously monitored using the Ohmeda 2300 Finapres. Patients were randomised to receive either propofol 2.5 mg.kg-1 (Group A) or thiopentone 4.5 mg.kg-1 (Group B). The mean time to complete laryngoscopy and intubation was 26 s in Group A and 20 s in Group B. The peak response occurred on average 31 s after the start of the stimulus in Group A and after 32 s in Group B. In 8 out of the 30 cases the peak response occurred during the period of stimulation. Systolic pressure fell on average by 2.6 kPa (20 mmHg) (range 0 to 5.9 (45 mmHg)) from its peak value to the value measured at the 1-min time mark in the propofol group, and by 2.3 kPa (17 mmHg) (range 0.4 (3 mmHg) to 3.8 (29 mmHg)) in the thiopentone group. We conclude that the use of slow arm-cuff-based arterial pressure measurement techniques may miss important hypertensive episodes during laryngoscopy and endotracheal intubation. The effectiveness of agents in obtunding the pressor response may thus be misinterpreted.

Psychomotor recovery after outpatient anaesthesia: individual impairment may be masked by group analysis

Recovery from outpatient anaesthesia with propofol was followed in 10 patients, using a semantic recognition memory test (SemRT) (in a new implementation on a Psion hand-held microcomputer), choice reaction time (CRT) and critical flicker fusion threshold (CFFT). Group analysis of results revealed an effect on psychomotor performance as measured by the SemRT and CFFT (but not the CRT), 30 min after the end of the procedure. Performance on all three tasks had returned to baseline values within 60 min of completing the anaesthetic. Group analysis, however, masks individual impairment which may be clinically important. There was no statistically significant correlation between post-anaesthetic task performance and age, sex, dose of propofol, anxiety or depression score.

Cardiovascular response to insertion of Brain's laryngeal mask

This study was designed to investigate the cardiovascular effects related to insertion of the Brain laryngeal mask airway and to compare these effects with those after insertion of a Guedel oral airway. Arterial pressure and heart rate in 100 patients were measured using an Ohmeda 2300 Finapres arterial pressure monitor. Arterial pressure decreased significantly (p less than 0.001) and heart rate increased significantly (p less than 0.001) after induction of anaesthesia with 2.5 mg/kg of propofol. A significant increase in arterial pressure (p less than 0.02) and in heart rate (p less than 0.001) followed insertion of the laryngeal mask and the Guedel airway, with no difference between the two groups at any time. The changes in arterial pressure and heart rate returned to 'at insertion' levels within 60 seconds of the stimulus.

Diagnostic library support system for medical practice

Here is a tragic case where the diagnosis was missed on three separate occasions over a 19-month period. Both terminal conditions are treatable and potentially separable if discovered and aggressively managed. It is not the intent of this presentation to criticize the evaluation of this patient, but rather to point out the need and, also, the potential benefits of an alternate approach, which could have significantly changed the course of this particular patient's evaluation. We have conducted similar analyses with other CPC cases with almost equivalent specificity. These same evaluations have been performed in a real clinical setting with live patient data. What we have learned so far we think will be extremely helpful in extending the potential application of this technology: A text-based decision support tool is only as good as its practitioner. It takes practice and training to learn to use this system effectively. There are many traps in logic, and the use of words and terms within the text must be understood to effectively utilize this tool. There are shortcuts in logical analysis which we mentally use all the time but which cannot be accepted using this system (e.g., you must not rely on your memory or any specific associations to circumvent the system). The system will only become clinically relevant when the entire field of medicine is included in the data base. This is one of our current limitations with only two-thirds of the Merck medical text available for reference. This makes it difficult to apply to a general medical problem since we are not sure which direction the case might take, and often these are multisystem diseases or problems that put us at a severe disadvantage if we don't have the necessary data base. The structure and integrity of the data base are critical to the success of the system. Since numbers are ubiquitous, these cannot be used for key word elements. Techniques must be introduced to create word-oriented numbers that can be uniquely identified (e.g., "AGE14-20"). The publisher of the data must supply a continuous flow of up-to-date material that can be incorporated within the framework of the working system. It is possible to train medical technicians to use the system if they are familiar with medical terminology. The speed and, perhaps, the precision of their analysis could not be expected to rival that of a medical specialist.(ABSTRACT TRUNCATED AT 400 WORDS)