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PubMedDate not supplied

Cystic fibrosis and lung transplantation: ethical concerns.

Cystic fibrosis is a multisystem disorder affecting respiratory, digestive, integumentary, and reproductive systems. Despite the medical advancements treating cystic fibrosis, lung disease is the leading cause of morbidity and mortality in children and adults. A case study of a 21-year-old's struggle to undergo double lung transplantation is presented, and four ethical considerations are identified. An ethical decision-making model provides an avenue for discussing these concerns.

Adult↗

PubMed1975

Hormonal control of integumentary water-loss: evidence for a novel neuroendocrine system in an insect (Periplaneta americana).

An accelerated water-loss was observed in decapitated individuals, no equivalent increase being obtained following severance of the nervous connectives in the neck. Injection of brain and, to a lesser extent, corpus cardiacum extract resulted in a significant reduction in the rate of loss of water from decapitated individuals. The accelerated water-loss observed following decapitation appeared not to result from significant increase in excretory output or loss of water through the spiracles. It is suggested that integumentary transpiration may be affected by a blood-borne factor, or factors, which originate in the brain and corpus cardiacum.

Animals↗

PubMed1998

Neoplastic diseases in ferrets: 574 cases (1968-1997).

OBJECTIVE: To determine incidence of neoplastic disease in ferrets. DESIGN: Retrospective study. ANIMALS: 574 ferrets with neoplastic disease. PROCEDURE: Medical records from the Veterinary Medical Data Base at Purdue University from 1968 to May 1997 were reviewed to identify ferrets with neoplastic disease. Data on tumor type, organ or system affected, sex, age, geographic location of affected ferrets, participating institution, and year of diagnosis were retrieved. RESULTS: 639 tumors of various types were diagnosed in 574 of 4,774 (12%) ferrets in the database. Sixty-one ferrets had multiple tumor types. Primary tumors were found in every system; endocrine (254; 39.7%), hemolymphatic (97; 15.2%), integumentary (83; 12.9%), and digestive (54; 8.4%) systems were most commonly affected. The most common tumor types were pancreatic islet cell (139; 21.7%) and adrenocortical cell (107; 16.7%) tumors and lymphoma (76; 11.9%). Most (94.2%) pancreatic islet cell tumors were functional. Age of affected ferrets ranged from less than 1 month to more than 15 years old. Tumor incidence was highest in ferrets between 4 and 7 years old. A sex predilection was not found, although tumors were found more commonly in spayed females and castrated males than in sexually intact females and males, respectively. Number of tumors diagnosed increased as the number of ferrets examined increased. Neoplastic disease accounted for an increasingly greater percentage of diseases diagnosed in ferrets during the study period. CLINICAL IMPLICATIONS: Ferrets have an incidence and spectrum of neoplastic disease similar to other mammalian species.

Age Factors↗

PubMedDate not supplied

Vogt-Koyanagi-Harada disease.

Vogt-Koyanagi-Harada disease (VKH) is a multisystem autoimmune disorder principally affecting pigmented tissues in the ocular, auditory, integumentary and central nervous systems. Patients are typically 20 to 50 years old and have no history of either surgical or accidental ocular trauma. Pigmented races are more commonly affected. Depending on revised diagnostic criteria, the disease is classified as complete, incomplete or probable based on the presence of extraocular findings (neurological, auditory and integumentary). The clinical course of VKH is divided into four phases: prodromal (mimics a viral infection), uveitic (bilateral diffuse uveitis with papillitis and exudative retinal detachment), convalescent (tissue depigmentation), and chronic recurrent (recurrent uveitis and ocular complications). The pathogenesis of VKH is thought to be related to an aberrant T cell-mediated immune response directed against self-antigens found on melanocytes. VKH has been linked to human leukocyte antigen DR4 (HLA-DR4) and HLA-Dw53, with strongest associated risk for HLA-DRB1*0405 haplotype. The diagnosis of VKH is clinical, and differential includes sympathetic ophthalmia, sarcoidosis, primary intraocular B-cell lymphoma, posterior scleritis, and uveal effusion syndrome. Treatment is typically initiated with high-dose oral corticosteroids, but other immunomondulatory agents (most oftentimes cyclosporine) may be needed for non-responsive patients or when corticosteroid side-effects are not tolerated. Visual prognosis is generally good with prompt diagnosis and aggressive immunomodulatory treatment.

Diagnosis, Differential↗

PubMed2003

Risks associated with the use of intravenous immunoglobulin.

Although US immune globulin intravenous (human) (IGIV) products have been regarded as safe, it is important to recognize that many of the controlled clinical studies of IGIVs have been of modest size and have limited power to define the incidence of only the most common adverse events (AEs). A significant number of "postmarketing" serious AEs affecting renal, cardiovascular, CNS, integumentary, and hematologic organ systems have been reported. Variables potentially affecting the risk and intensity of adverse events associated with administration of IGIV include patient age, underlying condition, history of migraine, cardiovascular or renal disease, dose, concentration, rate of infusion, specific brand/formulation/excipients, and lot(s) of the particular IGIV product being administered. Each manufacturer's IGIV preparation is a unique product carrying its own specific evidence-based indications and safety profile. In view of the seriousness of potential adverse effects of IGIV products, and current lack of data surrounding their frequency, clinicians are advised to limit their prescription of these products for conditions for which efficacy is supported by adequate and well-controlled clinical trials. Prescribers should pay close attention to patient selection; consider the potential risk/benefit ratio vis-a-vis alternate therapies; and familiarize themselves with the identification, management, and proposed strategies to minimize the risks of IGIV.

Humans↗

PubMed2003

Vogt-Koyanagi-Harada disease associated with interferon alpha-2b/ribavirin combination therapy.

The complex immunological effects of interferon and ribavirin therapy (IFN/R) in hepatitis C virus (HCV) may also exacerbate or trigger the de novo development of autoimmunity. We report the first case of IFN/R therapy associated with Vogt-Koyanagi-Harada disease, a T-cell-mediated autoimmune response to melanocytes. This condition, which has characteristic ocular, neurological and integumentary findings, elicits a systemic prodrome that may mimic side-effect profile and delay of IFN or mask its recognition. We discuss this disease in the context of the known immunomodulatory effects of IFN-alpha and ribavirin and suggest potential mechanistic explanations for the association.

Antiviral Agents↗

PubMed2002

Early recognition of Marfan's syndrome.

PURPOSE: To describe the classical features of Marfan's syndrome to help nurse practitioners (NPs) diagnose it in the early stages of progression and perhaps prevent many of its deleterious effects. DATA SOURCES: Selected research-based articles in the scientific literature and classic medical texts. CONCLUSIONS: The cause of Marfan's syndrome is unknown, but studies have linked it with a disorder of chromosome 15. It is a degenerative connective tissue disorder that affects the musculoskeletal, ocular, integumentary, respiratory, and neurologic systems. The most lethal effect is on the cardiovascular system causing dissecting aortic aneurysms. IMPLICATIONS FOR PRACTICE: Early diagnosis is essential for a positive course of management. Marfan's syndrome can have fatal consequences and is often underdiagnosed and misdiagnosed.

Aortic Aneurysm↗

PubMed1992

Elderly patients in critical care: an overview.

Elderly patients who enter the critical care setting have special nursing care needs based on the physiologic changes of aging. An overview of the changes of aging associated with the immunologic, cardiovascular, integumentary, musculoskeletal, and renal systems provides the basis for care planning to meet the needs of older adults in the intensive care unit.

Aged↗

PubMed2006

Comparative anatomy and histology of xenarthran osteoderms.

Reconstruction of soft tissues in fossil vertebrates is an enduring challenge for paleontologists. Because inferences must be based on evidence from hard tissues (typically bones or teeth), even the most complete fossils provide only limited information about certain organ systems. Osteoderms ("dermal armor") are integumentary bones with high fossilization potential that hold information about the anatomy of the skin in many extant and fossil amniotes. Their importance for functional morphology and phylogenetic research has recently been recognized, but studies have focused largely upon reptiles, in which osteoderms are most common. Among mammals, osteoderms occur only in members of the clade Xenarthra, which includes armadillos and their extinct relatives: glyptodonts, pampatheres, and, more distantly, ground sloths. Here, I present new information on the comparative morphology and histology of osteoderms and their associated soft tissues in 11 extant and fossil xenarthrans. Extinct mylodontid sloths possessed simple, isolated ossicles, the presence of which is likely plesiomorphic for Xenarthra. More highly derived osteoderms of glyptodonts, pampatheres, and armadillos feature complex articulations and surface ornamentation. Osteoderms of modern armadillos are physically associated with a variety of soft tissues, including nerve, muscle, gland, and connective tissue. In some cases, similar osteological features may be caused by two or more different tissue types, rendering soft-tissue inferences for fossil osteoderms equivocal. Certain osteological structures, however, are consistently associated with specific soft-tissue complexes and therefore represent a relatively robust foundation upon which to base soft-tissue reconstructions of extinct xenarthrans.

Anatomy, Comparative↗

PubMedDate not supplied

Spontaneous tumours in captive African hedgehogs (Atelerix albiventris): a retrospective study.

Forty tumours were diagnosed in 35 (53%) of 66 captive African hedgehogs documented at Northwest ZooPath (NZP) between 1994 and 1999. Three hedgehogs had more than one type of tumour and the remaining 32 had a single type. Of the 35 hedgehogs with tumours, 14 were female, 11 were male, and 10 were of unknown gender; 21 were from zoological parks and 14 were privately owned. Twenty of the hedgehogs with tumours were adult (>1 year old) with a median age of 3.5 years (range 2-5.5 years); 15, of unreported age, were classified as adult. Thirty-four (85%) of the 40 tumours were classified as malignant and six (15%) as benign. The integumentary, haemolymphatic, digestive and endocrine systems were common sites for tumours. The most common tumours were mammary gland adenocarcinoma, lympho-sarcoma and oral squamous cell carcinoma.

Animals↗

PubMed1991

Trematodes nervous system.

Three main themes are discussed: 1. Development of the nervous system in the ontogeny of digenetic trematodes; 2. Central and integumentary nervous elements in Cercaria echinata (Echinostomatidae), their evolution in metacercaria and adult; 3. Chaetotaxy and systematics. The structure of the nervous system in digenetic trematodes is based on the occurrence of various neurotransmitters in the nerve tissue. Two major trends in the evolution of the nervous system from cercaria to adult are discerned, one leading to definitive, small number of commissures, established early in the development of the cercaria, the other one leading to formation of great number of commissures completed in the adult. Structure of the nervous system in sporocystic and/or redial generations in various groups of trematodes is compared. Its primitiveness in relation to that of other generations is noted. The central nervous system of Cercaria echinata is pointed out by fixation in glioxylic acid and examination in green light fluorescence. The integumentary sensory elements observed in light microscope, SEM and transmission electron microscope reveal a large variety in structures; propositions are made about their functions. In the corresponding metacercaria, the anterior part of the central nervous system remains unchanged; meanwhile the posterior part increases; several integumentary sensory elements disappear and poorly developed structures, improve; in the adult, transformations are completed. In about 200 various species of cercariae, the sensory receptors are arranged in a conspicuous relation with the nervous system. The study of their number and position; the chaetotaxy is used in systematics and allows very accurate conclusions in specific or infraspecific identifications and in all high taxonomical levels: family, sub-order, super-order. In the same way, miracidial and redial chaetotaxy are used n taxonomy.

Animals↗

PubMed2006

Preparation of swine for the laboratory.

Swine are an important model in many areas of biomedical research. These animals have been used predominantly as preclinical models involving surgical and interventional protocols. The systems most commonly studied include cardiovascular, integumentary, digestive, and urological. Swine are intelligent social animals and require species-specific socialization and handling techniques. It is important to acclimate the animals to the facility and to personnel before they are placed on chronic protocols. Gentle handling techniques instead of forceful procedures are essential to their socialization. They require sturdy caging with specific construction standards, and toys for environmental enrichment. Because the species is covered by both the Animal Welfare Act and the US Department of Agriculture, interstate transport requires a health certificate with destination state-specific disease screening standards. This manuscript provides an overview of best practices that have been utilized in the authors' facility.

Acclimatization↗

PubMed1995

Hand injuries secondary to subcutaneous illicit drug injections.

We present a retrospective analysis of 32 patients admitted over a 5-year period to a metropolitan regional trauma center with recently induced subcutaneous ("skin pop") illicit drug injectional injuries involving the hand. Cocaine derivatives were the most frequently reported illicit drug used (75%). All patients had local disease manifested by subcutaneous abscess formation, and several had regional disease (cellulitis, lymphangitis, or lymphadenopathy), but only one patient had systemic illness. Microbiological analysis revealed endogenous integumentary and oral flora sensitive to oral preparations of several antibiotic medications including cephalosporins. Primary therapy included intravenous administration of antibiotic medications in all instances and simple incision and drainage under local anesthesia in 26 patients (81%). Six patients (19%) required more radical operative therapy. All patients were hospitalized and recovered without sequelae, with preservation of hand function after follow-up evaluation, which ranged from weeks to months, except for 1 patient who required digital amputation because of necrosis. Although the issue of compliance in terms of wound and general medical care for this patient population is problematic, analysis of the data suggested that patients with illicit drug injectional injuries of the hand confined to subcutaneous regions could be effectively and safely managed in outpatient settings by simple wound care and orally administered cephalosporin medications.

Abscess↗

PubMed2000

Bacteria and fungi of marine mammals: a review.

A list of the different bacterial and fungal agents isolated from marine mammals in different parts of the world is presented. Importance is given to some of the most recently identified bacterial agents, including Actinobacillus delphinicola, A. scotiae, and Brucella spp. A list, in alphabetical order, of bacteria recovered from different tissues or organs from marine mammals is presented for the integumentary, respiratory, digestive, genitourinary, and reticuloendothelial systems. Infectious bacterial agents associated with abscesses and with cases of septicemia are also listed. Information about the different fungal agents recovered from marine mammals is summarized. A section covering some of the zoonotic infectious agents recovered from marine mammals is included.

Animal Diseases↗

PubMed1976

Congenital deformities about the knee.

Congenital deformities about the knee are the result of abnormalities of all the anatomical structures that make up this joint. In some cases the structural changes observed are due to primary disorders of formation and growth of one or more of the anatomical components of the knee. Disorders are known to occur in the integumentary, muscular, ligamentous supporting, and skeletal systems. Examples of these disorders are seen in the bone dysplasias and joint laxity syndromes. In other cases exaggerated intrauterine positions of the limb seem to bring about certain adaptive changes in the embryological development of this joint. Epiphyseal dysplasias can lead to precocious arthropathy. Subluxation of the patella is often an indicator of a ligamentous laxity syndrome. It can also occur as a result of anatomical abnormalities of the femoral condyles or be due to congenital or acquired quadriceps fibrosis. Hypoplasia of the patella with dislocation is seen in the nail-patella syndrome.

Abnormalities, Multiple↗

PubMed1971

Syndromal approaches to the nosology of hereditary deafness.

Seventy types of hereditary deafness can be distinguished using the following features of the syndrome: 1) mode of genetic transmission, 2) characteristics of the deafness, 3) age of onset, 4) sonic frequencies involved and 5) associated abnormalities. The gene, in single or double dose, causing the hearing loss may also cause abnormalities of the external ear, or of the integumentary, visual, nervous, skeletal, or urinary systems. In this report the characteristics of the hearing loss in each of the types of hereditary hearing loss are reviewed in eight tables.

Abnormalities, Multiple↗

PubMed2005

Integration of morphological data sets for phylogenetic analysis of Amniota: the importance of integumentary characters and increased taxonomic sampling.

Several mutually exclusive hypotheses have been advanced to explain the phylogenetic position of turtles among amniotes. Traditional morphology-based analyses place turtles among extinct anapsids (reptiles with a solid skull roof), whereas more recent studies of both morphological and molecular data support an origin of turtles from within Diapsida (reptiles with a doubly fenestrated skull roof). Evaluation of these conflicting hypotheses has been hampered by nonoverlapping taxonomic samples and the exclusion of significant taxa from published analyses. Furthermore, although data from soft tissues and anatomical systems such as the integument may be particularly relevant to this problem, they are often excluded from large-scale analyses of morphological systematics. Here, conflicting hypotheses of turtle relationships are tested by (1) combining published data into a supermatrix of morphological characters to address issues of character conflict and missing data; (2) increasing taxonomic sampling by more than doubling the number of operational taxonomic units to test internal relationships within suprageneric ingroup taxa; and (3) increasing character sampling by approximately 25% by adding new data on the osteology and histology of the integument, an anatomical system that has been historically underrepresented in morphological systematics. The morphological data set assembled here represents the largest yet compiled for Amniota. Reevaluation of character data from prior studies of amniote phylogeny favors the hypothesis that turtles indeed have diapsid affinities. Addition of new ingroup taxa alone leads to a decrease in overall phylogenetic resolution, indicating that existing characters used for amniote phylogeny are insufficient to explain the evolution of more highly nested taxa. Incorporation of new data from the soft and osseous components of the integument, however, helps resolve relationships among both basal and highly nested amniote taxa. Analysis of a data set compiled from published sources and data original to this study supports monophyly of Amniota, Synapsida, Reptilia, Parareptilia, Eureptilia, Eosuchia, Diapsida, Neodiapsida, Sauria, Lepidosauria, and Archosauriformes, as well as several more highly nested divisions within the latter two clades. Turtles are here resolved as the sister taxon to a monophyletic Lepidosauria (squamates + Sphenodon), a novel phylogenetic position that nevertheless is consistent with recent molecular and morphological studies that have hypothesized diapsid affinities for this clade.

Animals↗

PubMed2003

Anticipating and treating opioid-associated adverse effects.

Opioids are frequently avoided as viable tools in the management of pain due to perceived dangerous or untoward adverse drug events. Whilst they are relatively safe options for the treatment of pain, side effects and toxicities do exist and should be anticipated by the provider. The central nervous, gastrointestinal, genito-urinary, integumentary, metabolic/endocrine, cardiovascular, pulmonary, hepatic/renal, ocular and immune systems all manifest changes associated with opioid therapy. These adverse events, ranging from nuisance to therapy-limiting, are manageable when addressed quickly and appropriately. Opioids are safe and efficacious analgesics when these effects are considered.

Analgesics, Opioid↗