Accountability and the health reforms.
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Cost Control↗
Biomedical subjects
M P Moore
Publications and source records attributed to M P Moore.
Approach to the patient with spinal disease.
The approach to the patient suspected of having spinal disease should be methodical to assure an accurate diagnosis that is cost-effective with minimal risk to the patient. Using a problem-oriented approach will facilitate attaining this goal. A neurologic examination should enable the veterinarian to localize to one of four spinal cord segments or the cauda equina.
Animals↗
Discospondylitis.
The etiopathogenesis and diagnosis of discospondylitis are reviewed. Various therapy options are described. Also included is a discussion of the appropriate usage of specific antimicrobial agents.
Animals↗
Quantitative electroencephalography for measurement of central nervous system responses to diazepam and the benzodiazepine antagonist, flumazenil, in isoflurane-anaesthetized dogs.
Quantitative EEG was assessed in six dogs anaesthetized with 1.8% end-tidal isoflurane concentration and following diazepam (0.2 mg/kg i.v.) administration. Ventilation was controlled to maintain normocapnia. Five dogs were subsequently given the benzodiazepine antagonist, flumazenil (0.04 mg/kg i.v.), and quantitative EEG was recorded. One dog received a saline injection following diazepam (as a control) and quantitative EEG was recorded for an additional 2.5 h. Heart rate, arterial blood pressure, esophageal temperature, arterial pH and blood gas tensions, end-tidal CO2 tension and end-tidal isoflurane concentration were monitored throughout the study. A 21 lead linked-ear montage was used for recording EEG. Quantitative EEG data were stored on an optical disc for analysis at a later date. Values for absolute power of EEG were determined for theta, delta, alpha, and beta frequencies. Cardiovascular parameters remained stable throughout the study. Diazepam administration was associated with decreased absolute power in all frequencies of EEG at all electrode sites. The duration of diazepam-induced decreased absolute power of EEG was at least 3 h in one dog. Administration of flumazenil antagonized diazepam-induced decreased absolute power of EEG in all frequencies at all electrode sites. We conclude that quantitative EEG provides a relatively non-invasive, objective measure of diazepam- and flumazenil-induced changes in cortical activity during isoflurane anaesthesia.
Anesthesia, Inhalation↗
Temporal variation in incidence of IDDM in Canterbury, New Zealand.
OBJECTIVES: To establish the statistical significance of observed variations over the last decade in the incidence of insulin-dependent diabetes mellitus (IDDM) in the 0- to 19-yr-old age-group and to determine whether incidence has increased in Canterbury, New Zealand. RESEARCH DESIGN AND METHODS: The Canterbury, New Zealand, Diabetes Registry has recorded all incidence cases of diabetes mellitus prospectively since 1982. All IDDM subjects aged 0-19 yr at diagnosis and using insulin are included in the study. Ascertainment is believed to be 100%. Prevalence was recorded at 1 January 1982 and 1 January 1990. Annual incidence for 1982-1990 was determined using age and sex cross-sectional census population denominators. The statistical significance of temporal, age, sex, and seasonal variations in incidence rates was ascertained by Poisson regression models (GLIM statistical software). RESULTS: Prevalence on 1 January 1990 was 115/100,000. Incidence rates during the 9 yr were periodic, with two major peaks--one in the early 1980s, the other in 1989 continuing into 1990. The temporal variation (P less than 0.02) was not age or sex specific. Incidence rates for boys were three- to fourfold higher during peak versus trough years, with a peak level of 20.7/100,000 in 1990. For girls, there was less variation, with a peak rate of 21.6/100,000 in 1990. There has been no significant increase in IDDM incidence over time. The mean rate of incidence across all age-groups for 1982-1990 was 12.7/100,000 person-yr. A significant seasonal association to the onset of IDDM was found only in boys, with incidence rates being significantly higher in winter than in summer (P less than 0.01). CONCLUSIONS: IDDM in Canterbury, New Zealand, presents in cycles of incidence peaks and troughs, each spanning 2-3 yr.
Adolescent↗
Urethral pressure response to alpha-adrenergic agonist and antagonist drugs in anesthetized healthy male cats.
Urethral smooth muscle tone in response to treatment with phenylephrine, a selective alpha 1-adrenergic receptor agonist, and prazosin a selective alpha 1-adrenergic receptor antagonist, was evaluated in 12 anesthetized healthy adult sexually intact male cats. Intravenous administration of prazosin (20 to 30 micrograms/kg of body weight) decreased the average preprostatic and prostatic intraurethral pressure, compared with baseline and postphenylephrine (20 to 30 micrograms/kg) administration, values. Neither prazosin nor phenylephrine administration had an effect on functional urethral length. Results have implications for the pharmacologic management of lower urinary tract disorders in male cats.
Analysis of Variance↗
Inflammatory breast cancer.
Historically, the prognosis of inflammatory breast cancer has been poor. We conducted a retrospective review to evaluate the recent Memorial Sloan-Kettering Cancer Center experience, to evaluate the role of combination chemotherapy, and to compare the effect of surgery and radiation on local/regional failure. Fifty-six patients with local/regional inflammatory breast cancer diagnosed between 1975 and 1984 were identified. All were treated with combination chemotherapy. Overall 5-year survival was 45% with a 5-year disease-free survival rate of 37%. Twenty-one patients were treated with induction chemotherapy followed by mastectomy and adjuvant chemotherapy. Survival and disease-free survival rates were similar to those achieved in patients treated with mastectomy followed by chemotherapy. Residual cancer was found in all 21 patients treated with induction chemotherapy, with extensive disease present in 18, including six of seven complete responders. The local/regional failure rate was 34%.
Adult↗
Quantitative electroencephalography in dogs anesthetized with 2.0% end-tidal concentration of isoflurane anesthesia.
Quantitative electroencephalography was assessed in dogs under controlled, 2% end-tidal isoflurane anesthetic conditions, and each variable at each electrode site was tested for normal distribution. With the quantitative electroencephalographic system used, 16 values for each of 21 electrode sites were evaluated. Absolute power ratios also were evaluated. The methods for quantitative electroencephalographic recording and analysis appear to be readily adaptable to the dog. Most of the data do not conform to a normal distribution. Therefore, distribution-free nonparametric statistics should be used when looking for differences under experimental or clinical conditions. Quantitative electroencephalography appears to be a sensitive noninvasive method that could be used to evaluate brain function under anesthetic, clinical, and experimental settings.
Acid-Base Equilibrium↗
Occult breast cancer presenting with axillary metastases. Updated management.
An isolated axillary lymph node metastasis in a woman without an obvious clinical primary site most frequently originates from the breast. Mastectomy has been the historical treatment of choice. A retrospective study of 35 patients was undertaken to evaluate the roles of modern mammography, breast preservation, and adjuvant systemic therapy in the management of these patients. Twenty-eight patients underwent a mastectomy, while 7 were managed by a combination of limited resection and/or axillary dissection and radiation therapy. Twenty-two (67%) of the 33 breast specimens contained carcinoma. Comparison of the pathologic results with the preoperative mammograms showed a specificity of 73%, while the sensitivity was only 29%. Actuarial 5-year survival after mastectomy or breast preservation was similar (77% and 65%, respectively). Patients with more than one positive lymph node benefited from adjuvant therapy. Mammography does not locate the majority of occult stage II breast cancers, and both breast preservation and adjuvant therapy may have roles in the management of these patients.
Adenocarcinoma↗
Severe secondary amyloidosis in a dog with dermatomyositis.
A male collie aged 5 years 10 months, which developed dermatomyositis at 2 months of age, died from severe secondary amyloidosis. Amyloid deposition was most severe in renal glomeruli and produced renal failure. Amyloidosis has been reported in man with immune-mediated disorders including rheumatoid arthritis, systemic lupus erythematosus and dermatomyositis. It is possible that the inflammation in this case of familial canine dermatomyositis may have predisposed to the development of amyloidosis.
Amyloidosis↗
HIV infection and Scottish general practice: workload and current practice.
To estimate the effect of human immunodeficiency virus (HIV) infection on general practice, a postal survey was undertaken of one in three of all principals in Scotland. Of the 834 general practitioners who responded (78% response rate), 31% were working in practices with patients known to be infected with HIV. The estimated prevalence of known HIV infection in general practice was 19 per 100,000 population, and the estimated annual consultation rate for HIV related problems (including consultations by the 'worried well') was seven per 1000 population. Both statistics showed considerable variation between health boards, with peaks in Lothian and Tayside. Few practices had drawn up policies relevant to HIV infection, and the use of procedures for controlling infection was variable. Policies about HIV and for infection control tended to be more common in areas where the prevalence of HIV infection was higher. Most respondents were offering both opportunistic health education and counselling about HIV infection, especially to patients at high risk. Although general practitioners are responding positively to the increasing demands of HIV infection, there is an urgent need for policies, both national and local, to guide specific aspects of practice.
Acquired Immunodeficiency Syndrome↗
HIV infection and Scottish general practice: knowledge and attitudes.
To assess the knowledge and attitudes of general practitioners about HIV infection, a postal survey was undertaken of one in three of all principals in Scotland; 834 (77.6%) responded. Respondents' knowledge about HIV was often limited, and they found the discussion of sexual behaviour difficult. Most were in favour of routine HIV testing being offered to patients, but against testing without consent. Most general practitioners considered consent unnecessary for the passing of information about HIV status between medical colleagues, but necessary for informing others, in particular the patient's family and sexual partners. Most general practitioners would accept high-risk and HIV-positive patients onto their lists but less than half would accept intravenous drug users. Most respondents did not feel at significant personal risk of HIV infection, but expressed reservations about many other aspects of HIV infection in general practice. If practitioners are to fulfil their potential for tackling the problems of HIV infection, they need increased resources and a policy for education and training that is responsive to local needs.
Acquired Immunodeficiency Syndrome↗
Medical mentors. The people who shape tomorrow's doctors.
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Curriculum↗
Complement levels in dogs with familial canine dermatomyositis.
CH50, C4, C2, and C3 levels were evaluated in 7 dogs affected with dermatomyositis and in 22 control dogs. Dogs with dermatomyositis did not have clinical evidence of active disease at the time of serum collection for complement assays. No absolute complement component deficiency was identified in dermatomyositis-affected dogs in this study; however, a statistical difference in C2 was identified between control dogs of non-collie breeds and control collies, suggesting there may be a breed difference in complement levels.
Animals↗
Shin splints. Diagnosis, management, prevention.
Our knowledge of the etiology of shin splints is incomplete. Biomechanical abnormalities are likely to be major factors in predisposing certain persons to such injury. Also, training errors are major etiologic factors. Because shin splints result from mechanical overload of various elements of the musculoskeletal system of the leg that exceed their adaptive remodeling capacity, rest and recovery should be emphasized as an important aspect of sports training. Accurate and prompt diagnosis reduces the severity and duration of the injury. Management should consist of measures to reduce inflammation and pain and to identify possible biomechanical factors that may be correctable by strengthening and flexibility exercises or by the use of an orthotic device.
Athletic Injuries↗
Hormonal and metabolic effects of enalapril treatment in hypertensive subjects with NIDDM.
The effects of enalapril treatment on blood glucose, insulin, and C-peptide levels and effects on the renin-angiotensin aldosterone system were studied in 22 hypertensive patients with non-insulin-dependent diabetes. After a 4-wk run-in period during which all previous antihypertensive drugs were discontinued, treatment was commenced with one daily dose of 10 mg enalapril. The dose was adjusted upward at 3-wk intervals to a maximum of 40 mg daily. In 3 subjects, addition of a thiazide diuretic was required after 9 wk of treatment. At completion of run-in and after 9 and 13 wk of treatment, subjects had blood samples drawn after fasting and 2 h after a standardized 1.6-mJ mixed meal. Mean fasting blood glucose at the end of the run-in period was 8.3 +/- 0.5 mM and at study completion was 7.3 +/- 0.4 mM. Mean postprandial blood glucose was 10.8 +/- 1.0 mM before treatment and 9.8 +/- 0.7 mM at study completion. The changes in fasting and postprandial blood glucose levels were not significant (P = .06 and P = .15, respectively). There was no significant change in glycosylated hemoglobin levels. Fasting and meal-stimulated insulin and C-peptide levels were not altered by enalapril treatment. Treatment was associated with a sustained reduction in plasma angiotensin-converting enzyme activity, an increase in plasma renin activity, reduced plasma aldosterone levels, and significant reductions in supine, seated, and standing arterial blood pressures.(ABSTRACT TRUNCATED AT 250 WORDS)
Blood Glucose↗
Trauma systems. Where does Minnesota really stand?
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Forecasting↗
Cecal perforation and adrenocortical adenoma in a dog.
Cecal perforation was diagnosed in a dog with a history of acute vomiting. The dog also had an adrenocortical adenoma. Intestinal perforation can be a serious complication of cortico-steroid treatment in the dog, but has not been attributable to hyperadrenocorticism. Fever and an inflammatory CBC were not observed, which could have been secondary to adrenal-dependent hyperadrenocorticism. The acute abdominal crisis associated with peritonitis required quick resolution in an attempt to save the dog, but also precluded any further diagnostic procedures for possible hyperadrenocorticism. The signs that suggested hyper-adrenocorticism in this dog included alopecia, lymphopenia, eosinopenia, high liver enzyme activities, hypercholesterolemia, and one large and one small adrenal gland. This latter finding presumably indicated negative feedback suppression and atrophy attributable to a functional adrenocortical adenoma.
Adenoma↗