Instrumentation and techniques for treating orthopedic infections in horses

Orthopedic infections-those involving bones, joints, tendon sheaths, or bursae-are some of the most difficult problems for equine surgeons to treat successfully. Sources of the infection are usually hematogenous, traumatic, or iatrogenic and knowledge of the most likely causative bacteria is very useful in selecting the most appropriate antimicrobial(s) to either prevent or treat these infections in horses. This article discusses the clinical findings, diagnosis, treatment, and prevention of orthopedic infections in horses. More recent treatment methods such as synovial drainage techniques (arthroscopy and arthrotomy), intrasynovial antimicrobials, regional perfusion of antimicrobials, and antimicrobial-impregnated polymethylmethacrylate (PMMA) beads or cylinders are also addressed.     

A Bayes-optimal sequence-structure theory that unifies protein sequence-structure recognition and alignment

A rigorous Bayesian analysis is presented that unifies protein sequence-structure alignment and recognition. Given a sequence, explicit formulae are derived to select (1) its globally most probable core structure from a structure library; (2) its globally most probable alignment to a given core structure; (3) its most probable joint core structure and alignment chosen globally across the entire library; and (4) its most probable individual segments, secondary structure, and super-secondary structures across the entire library. The computations involved are NP-hard in the general case (3D-3D). Fast exact recursions for the restricted sequence singleton-only (1D-3D) case are given. Conclusions include: (a) the most probable joint core structure and alignment is not necessarily the most probable alignment of the most probable core structure, but rather maximizes the product of core and alignment probabilities; (b) use of a sequence-independent linear or affine gap penalty may result in the highest-probability threading not having the lowest score; (c) selecting the most probable core structure from the library (core structure selection or fold recognition only) involves comparing probabilities summed over all possible alignments of the sequence to the core, and not comparing individual optimal (or near-optimal) sequence-structure alignments; and (d) assuming uninformative priors, core structure selection is equivalent to comparing the ratio of two global means.     

Common office problems in pediatric urology and gynecology

The number of genital problems that pediatricians encounter is substantial. The most common ones have been reviewed in this article. Perhaps the most important point to reinforce is the appropriateness of nonintervention in uncircumcised boys whose foreskins have not become retractile during early school years. Without infections or pathologic phimosis, these boys do well, and most foreskins become retractile as they approach puberty. Abnormalities beyond those discussed or those not fitting the anticipated pattern probably warrant specialty referral.     

Axillary basal cell carcinoma: a need for full cutaneous examination

Basal cell carcinoma is the most common skin malignancy. While this lesion most often occurs in sun-exposed areas of the skin, it can also develop in sites that are not usually exposed to sunlight or artificial ultraviolet radiation, such as the breast, palm or groin. A periodic complete examination of the skin should be performed to ensure that atypical presentations of basal cell carcinoma are not overlooked or misdiagnosed. Treatment options include curettage and desiccation, cryosurgery, surgical excision, radiotherapy and Mohs micrographic surgery.     

Routine inquiry into sexual victimization: A survey of therapists' practices.

Surveyed therapists regarding their practices in assessing clients' sexual abuse history. Of the 105 respondents, 51% reported that they routinely ask all clients or most clients about sexual abuse at some time during the course of therapy; 19% reported that they had asked only a few clients or that they never ask clients directly about sexual abuse. Therapists who were younger, who had been in practice for a shorter period of time, and whose current caseload included a high percentage of sexually abused women were most likely to have asked all or most of their clients about having been sexually abused. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beyond imitation: Complex behavioral and affective linkages resulting from exposure to leadership training models.

Examined the influence of modeling interventions in a training situation on short-term leader behavior and on subsequent subordinate affective response using 40 leader–subordinate dyads. Ss read scenarios describing setting and 4 performance objectives; then they role-played as supervisor, subordinate, or observer. Three separate videotapes of a supervisor–subordinate interaction were prepared for supervisors that emphasized positive reward, reprimand, or goal-setting behavior. Ss viewed 1 of the videotapes or were assigned to a control condition in which no videotape was used. Results of subsequent role-playing indicate a significant overall change in leader behavior in response to the videotape modeling interventions. In addition, positive reward behavior was most responsive to the reprimand intervention, reprimand behavior was most responsive to the goal-setting intervention, and goal-setting behavior was most responsive to the reprimand intervention. Findings suggest that the modeling process should be viewed as a complex phenomenon involving multiple behavioral and affective linkages that go beyond a simplistic imitation or demand effect interpretation. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute spinal-cord lesions from diving--epidemiological and clinical features

The aquatic activity that produces the greatest number of spinal-cord lesions is diving. Persons in the general population at greatest risk are males aged 15 to 19 years. Of the cases identified, 45 percent resulted from diving into a river or stream, 27 percent into swimming pools and 28 percent into lakes, reservoirs or the ocean. Distribution by age differed for the major groups of bodies of water. The incidence of spinal-cord injuries was related to season (spring-summer) and day of the week (weekends). The incidence of injuries was highest in those county areas with the least opportunity for exposure to swimming pools or rivers. Of the injured persons, 60 percent were tetraplegic at hospital admission. The most frequent radiologic finding was wedge fracture. This finding, in the absence of objective evidence that most divers struck the bottom of the water reservoir or a hard object, suggests that hyperventroflexion was the mechanism responsible for injury in most of the cases. Physicians and others should be aware of strategy options for preventing or reducing such injuries.     

What's new in stroke?

More than 30,000 strokes occur each year in Texas, even though most strokes can be prevented by currently available and well-tolerated therapies. Antiplatelet therapy with aspirin or ticlopidine reduces stroke by about 25% in many patients with transient ischemic attack or initial stroke. Warfarin should not be used routinely for primary cerebrovascular disease but is useful to prevent cardioembolic stroke. Carotid endarterectomy is highly beneficial for patients with symptomatic, high-grade carotid stenosis, but its value for lesser degrees of symptomatic carotid plaque and for asymptomatic stenosis is less clear. Patients with nonvalvular atrial fibrillation have a substantial risk for stroke; most should be treated with warfarin. Risk-factor management (eg, control of hypertension, cessation of smoking, and treatment of hyperlipidemia) is as important as antithrombotic or surgical therapies for most patients with threatened stroke. Treating isolated systolic hypertension in elderly patients reduces stroke risk. Determining the cause of threatened stroke strongly influences preventive management. The tools are at hand to prevent most strokes; the challenge remains to apply them optimally.     

In smoke's way: Socioemotional reactions to another's smoking.

Assessed the immediate impact of second-hand cigarette smoke on interpersonal attraction and personal feelings. 75 US Army and Air Force enlisted men who were either nonsmokers or smokers and who either refrained or indulged during the session interacted with a stranger who either did not smoke, smoked courteously, or smoked discourteously. Following the encounter, Ss rated the other person on several evaluative dimensions and also rated their own affective state. Nonsmoking Ss made more favorable evaluations and reported a more pleasant affective experience after interacting with a nonsmoking stranger as compared to either a courteous or a discourteous smoker. Smoking Ss who refrained made their most positive ratings in the presence of a courteous smoking other and their most negative ratings in the company of a discourteous one. In contrast to both nonsmokers and smokers who refrained, smokers who indulged during the session made the most favorable ratings when exposed to an indiscriminant smoking stranger. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What's new in preventing and treating osteoporosis?

Women should be encouraged to maintain an adequate calcium intake throughout their life so they have good BMD when they reach menopause. The most effective choice for prevention and treatment of osteoporosis after menopause is estrogen or combined estrogen-progestin. The addition of progestin to estrogen therapy to prevent endometrial cancer does not impair effectiveness of estrogen in increasing BMD. In women who have contraindications to or do not wish to take estrogen, alendronate is the most effective alternative. Raloxifene has been found to protect BMD but not to the extent of estrogen or alendronate, and it does not provide the other benefits offered by estrogen. Calcitonin-salmon has an excellent long-term safety record, but its effectiveness in preventing fracture remains to be fully demonstrated. Adequate calcium intake and exercise are important adjuncts to other therapies but alone do not prevent osteoporosis in most women.     

Salivary gland involvement in systemic diseases

The salivary glands participate in systemic illnesses because they are secretory structures allied with the gastrointestinal tract. Thus they are involved in systemic inflammatory, allergic, and neoplastic conditions. Perhaps the most common condition is that of mumps in the acute phase. Of the chronic diseases, Mikulicz's disease or Sj?gren's syndrome is most frequently noted. In most instances of systemic involvement, the salivary gland enlargement is the rule, with the gland being tense, soft, and enlarged, and with progressive growth over a period of time. Usually all glands are involved. The diagnosis should be suspected from the history and the physical examination, noting that all the glands are equally involved by the enlargement. If there is any question, a biopsy should be performed. In the case of Sj?gren's syndrome, the biopsy specimen may be taken either from a major salivary gland or from one of the minor ones, or the nasal mucous membrane or oral cavity. In general, definitive therapy is unsuccessful for the systemic illness involving the salivary glands, and in most instances has to be supportive.     

Surgical operations in the United States. Then (1983) and now (1994)

OBJECTIVE: To study the hypothesis that numbers of surgical operations in the United States have increased from 1983 and 1994. DESIGN: Analysis of data from the National Center for Health Statics. SETTING: Short-stay general and specialty noninstitutional hospitals, and freestanding ambulatory surgical facilities, exclusive of federal, military, and Veterans Affairs hospitals. PATIENTS: Five-percent national sample. MAIN OUTCOME MEASURE: Ten most frequent surgical operations or classes of surgical procedures within neurosurgery, ophthalmology, otorhinolaryngology, cardiothoracic surgery, general surgery, urology, obstetrics and gynecology, and orthopedics. RESULTS: In 1994, the 10 most frequently performed surgical operations in the United States totaled 7,929,000 cases. This contrasted with 5,731,000 top 10 procedures in 1983, or an increase of 38%. The most common surgical operation in 1994 was cataract extraction, totaling 2,049,000 cases. Groin herniorrhaphy (689,000 procedures) remained the most common operation performed by a general surgeon. Cesarean section was the most frequently completed obstetrical-gynecological operation (858,000 procedures) and the country's second most common surgical procedure in 1994. Arthroscopy of the knee (632,000 procedures) demonstrated enormous growth (153%) and was the country's seventh most frequent operation in 1994. Transurethral prostatectomy (229,000 procedures) underwent the most precipitous decline (29%) of any No. 1-ranked specialty procedure. CONCLUSIONS: Numbers of top 10 surgical operations have increased in every surgical specialty except obstetrics-gynecology. Explanations may be the presence of new technologies, willingness of a preexisting reservoir of patients to undergo now less anxiety-provoking procedures, or less stringent indications.     

Influential works and authors in psychology: A survey of eminent psychologists.

Surveyed 19 experimental, 13 personality and/or clinical, 9 developmental and/or educational, and 16 social psychologists who were among the 102 most frequently cited psychologists in the 1975 Social Science Citation Index to determine the works and authors in the field they found most influential. Two of the authors, both experimental psychologists, were women; all Ss received their PhDs between 1927 and 1967. 39 authors and their cited works are listed. Freud was most frequently cited by Ss receiving PhDs before 1951; B. F. Skinner was most frequently named by those granted PhDs since 1951. As expected, there were substantial differences between works that were most often cited as influential by these authors and the readings that were most often recommended by graduate faculties surveyed in previous research: The authors' list of readings tended more toward the theoretical, while the works recommended by faculties are largely compendia of empirical work. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Significance of head turn sequences in temporal lobe onset seizures

We studied head turning in 239 complex partial seizures with or without generalization, in 32 patients with unilateral temporal lobe epilepsy. Head turns occurred in 73% of seizures that did not evolve to focal jerking or secondary generalization, and in all 41 seizures that secondarily generalized. In seizures without focal jerking or secondary generalization the most common pattern was that of single head turns (70%) which were ipsilateral to the focus in 94%. The next most common pattern was that of two or more head turns, with the first two turns in the same direction (19%), always ipsilateral to the focus. In seizures with secondary generalization, the most common sequence was that of two head turns contralateral to each other (59% of seizures). The first was always ipsilateral to the focus, associated with dystonic posturing in 96%, and was not tonic in character. The second was always contralateral, was tonic in character, and was still present within five seconds of secondary generalization or focal jerking. Our results suggest different patterns and sequences of head turning temporal lobe complex partial seizures without, and those with focal jerking or secondary generalization. Some sequences have powerful lateralizing value that can complement other lateralizing features.     

A national survey of percutaneous central venous catheter practices in neonates

PURPOSE: This study was conducted to describe current practices for maintenance of percutaneous central venous catheters (PCVCs). DESIGN: A survey technique was used. SAMPLE: A national mailing to 511 nurseries resulted in a response from 309. Of those who responded, 206 reported using PCVCs. MAIN OUTCOME VARIABLE: Maintenance practices for PCVCs. RESULTS: The most common catheter site preparation technique was the use of Betadine, or Betadine and alcohol. Transparent dressings were the most commonly used site cover, and were changed when loose or soiled. Contamination precautions varied; most nurseries used Y-administration sets and extension tubing for medication administration into the PCVC system.     

Gastric smooth muscle tumors: diagnostic dilemmas and factors affecting outcome

We reviewed the 46 gastric stromal tumors that were treated at our institution between 1958 and 1992. The most common presenting symptoms were gastrointestinal bleeding, pain, and fatigue or malaise. The tumors ranged from 4 to 150 mm, with surgery most often being a wedge excision or partial gastrectomy. Abdominal computed tomography was the most specific diagnostic test obtained preoperatively. Factors associated with decreased survival included size >/= 8 cm (p = 0.02), more than 0-3 mitoses per 10 HPF (p < 0. 001), positive margins or unresectability (p = 0.008), and tumor pathologic grade II or more (p = 0.004). These tumors have an unpredictable behavior. Surgical resection with negative margins remains the best therapy, but resection for palliation is sometimes indicated as it can be associated with prolonged survival.     

Doping of horses

Tobogganing is a very popular outdoor winter recreational activity. In order to elucidate the patterns of injuries associated with tobogganing all patients with an injury caused by falls from or collisions while on or being hit by a sled were sampled prospectively between the period of November 1996 and March 1997. 50 patients were included in this study, aged from 7 to 69 years (mean 25.5 years). Of these, 14 (= 28%) patients required admission to hospital lasting from 1 to 31 days (mean 13.5 days), 11 (22%) needed an operation. Over all we could register 55 injuries; the lower extremity was the region most commonly injured (63.6%), followed by upper extremity with 21.8%. The most common injury was the sprain of the knee. The most severe injuries could be found at the lower limb and at the vertebral column, including four fractures of the lower leg and 8 ankle-joint fractures as well as two fractures of the lumbar spine. The most common single procedure was the open reduction and internal fixation of a fibular fracture. In 48.6% of the cases the riders struck an object (tree, wall, post), while 32.4% fell from the toboggan caused by environmental conditions such as a bump or a ditch. The most important risk factor was an unadjusted speed referred to the environmental circumstances. Preventive strategies include tobogganing in adequate environmental conditions with no trees, no post or other stationary objects that could result in a collision. Speed should be adapted to the slope conditions.     

Assessment of patients' health status--review of the literature and assessment methods

The question often arises of how health status is to be measured, or to what end. A number of instruments have been developed for the measurement of patient health, and the article consists in a review of the methodology and specific applications of some of those most commonly used, as outlined in published reports. The review showed the defined goal (s) of investigation to constitute a crucial determinant of the choice of methods, as most of the available instruments are designed for specific situations or categories of patients. Thus, an unfortunate choice may result in sufficient or erroneous data for the purposes of decision making.