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Congenital Talipes Equinovarus (CTEV) is one of the most common congenital limb deformities. We reviewed the records of infants who had received treatment for structural CTEV between 1 January 2007 and 30 November 2012. This was cross-referenced with the prenatal scans of mothers over a corresponding period of time. We investigated the sensitivity, specificity, and positive and negative predictive values of the fetal anomaly scan for the detection of CTEV and explored whether the publication of Fetal Anomaly Screening Programme guidelines in 2010 affected the rate of detection.During the study period there were 95 532 prenatal scans and 34 373 live births at our hospital. A total of 37 fetuses with findings suggestive of CTEV were included in the study, of whom 30 were found to have structural CTEV at birth. The sensitivity of screening for CTEV was 71.4% and the positive predictive value was 81.1%. The negative predictive value and specificity were more than 99.5%. There was no significant difference between the rates of detection before and after publication of the guidelines (p = 0.5).We conclude that a prenatal fetal anomaly ultrasound screening diagnosis of CTEV has a good positive predictive value enabling prenatal counselling. The change in screening guidance has not affected the proportion of missed cases. This information will aid counselling parents about the effectiveness and accuracy of prenatal ultrasound in diagnosing CTEV.Cite this article: Bone Joint J2014;96-B:984–8.

Grazing of livestock on pasture land can result in changes to the physical condition of soil, particularly as a result of trampling and changed organic matter status of the topsoil. Over time, changes to pasture botanical composition may also occur, which might further affect soil structure. The extent of the effects, and the rate of soil and pasture recovery when livestock are removed, will depend on the grazing management tactics employed. A field study was established at Orange, New South Wales, to compare soil physical properties under ‘set-stocked' grazing of Merino sheep, ‘high intensity–short duration' rotational grazing, an ungrazed control, and pasture cages. Topsoil bulk density, hydraulic conductivity, and organic carbon content were measured annually over 3 years, and image analysis of soil macroporosity was carried out annually to quantify changes in pore geometry. Only the topsoil macropore properties changed significantly between treatments over the 3 years. In particular, the structural quality of the topsoil under set-stocked grazing changed, as indicated by a decrease in total macroporosity and a smaller proportion of macropores. In contrast, stable structural conditions were maintained under rotational grazing. Possibly the best soil structure for plant growth, represented by high values of total macroporosity and macropore surface area, and a large range of pore sizes, was exhibited under the pasture cages, where pasture defoliation occurred in the absence of hoof pressure. It is concluded that grazing tactics are an important factor in the dynamics of soil macroporosity and the vertical continuity of macropores, as a result of the combined effects of hoof pressure and root channel development.

Dopamine is an inotrope effective in the short term treatment of acute heart failure - including that caused by coronary artery disease. Catecholamines however can potentiate platelet activation and pre-dispose to coronary thrombosis.

This report describes the gross, microscopic, and immunohistochemical features of an invasive epithelial mesothelioma in an 11-year-old neutered male Golden Retriever. The tumor involved the pericardium, pleura, mediastinum, and peritoneum and invaded into submesothelial tissues. Neoplastic cells in the thoracic fluid showed prominent features of malignancy in a background of mixed inflammatory cells and scattered erythrocytes. Histologically, the tumor consisted of nests of epithelioid cells with frequent mitotic figures and multinucleation that infiltrated submesothelial tissues. Neoplastic cells strongly coexpressed vimentin and cytokeratin intermediate filaments, which assisted in the differentiation from other epithelial tumors of nonmesothelial origin.

The origin of the modern intensive care physician is the anesthesiologist. Initially, having expertise in oxygen delivery, anesthesiologists provided care to critically ill patients during polio epidemics and cardiac surgery. Later, an anesthesiologist called for the creation of a new subspecialty which has become known as intensive care. The intensivist is the physician responsible for the total care of the critically ill patient in the intensive care unit. Many studies have shown that the intensivist decreases the mortality and morbidity of the critically ill patient, in addition to improving the efficiency of patient care. Although the intensivist is central to the function of critical care units, the origins of the modern-day intensivist remain elusive and ill defined. In the early 20th century, an anesthesiologist defined "anoxemia" and its treatment in the postoperative period. Later, treatment of hypoxia was improved with oxygen delivery via nasal mask. In the 1950s, the polio epidemic and the development of cardiac surgery led to critically ill patients being collected in large wards. Anesthesiologists played an important role in the care of these patients. In the early 1960s, an anesthesiologist identified the need for the intensivist. This paper explores the development of anesthesiologists into intensivists.

This article describes the historic experience of the development of antiemetic guidelines for patients taking chemotherapy drugs at Mayo Clinic Rochester. The initial guidelines for the use of serotonin (5-hydroxytryptamine.,) receptor antagonists for the prevention of chemotherapy-induced nausea and vomiting were developed in early 1995 and implemented in September 1995. In February 1997, the guidelines were reviewed and modified. In the spring of 1998, major changes were made based on new data from the literature and discussions with antiemetic authorities in the United States. These guidelines were implemented in July 1998, The guidelines were again reviewed and modified in December 1998. In addition, we compared costs associated with the 1997 guidelines and the December 1998 guidelines. The developed guidelines, utilizing clinically available agents, seem to provide high-quality patient care at a reasonable cost.

Bacteriologic cultures were performed on the tips of pulmonary artery catheters removed from 153 critically ill patients, who had required pulmonary artery catheterization for management of hypovolemic or septicemic shock or for hemodynamic monitoring during mechanical ventilation with positive end-expiratory pressure. Positive results were obtained in 29 (19%) of the cases. Infection of indwelling pulmonary artery catheters may result from contamination during placement or removal or from transient or persistent bacteremia. Colonization was probable in 17 cases, and contamination in 12. There were no instances of sepsis definitely attributable to the catheter. Positive catheter-tip culture was associated significantly with known presence of a focus of infection before catheter insertion and with periods exceeding four days that the catheter remained in place.(JAMA 1981;245:1032-1036)

The effect of corticosterone treatment on the sensitivity of muscle protein synthesis to insulin infusion was assessed in post-absorptive young rats. To select the optimal time period for corticosterone treatment, protein synthesis was measured by injection of L-[2,6-3H]phenylalanine (1.5 mmol/kg body weight) 1, 4, 12 or 24 h after injection of corticosterone (5 mg/kg body wt.). Muscle protein synthesis was significantly decreased at 4 h and the effect was maximal by 12 h; liver protein synthesis was elevated at 12 h and 24 h. The dose-response of muscle protein synthesis to a 30 min infusion with 0-150 munits of insulin/h was then compared in rats pretreated with corticosterone (10 mg/100 g body wt.) or vehicle alone. When no insulin was infused, corticosterone inhibited protein synthesis in gastrocnemius muscle. High doses of insulin stimulated protein synthesis, but the inhibition by corticosterone was similar to that in the absence of insulin. At intermediate doses of insulin there was an increased requirement for insulin to elicit an equivalent response in muscle protein synthesis. Plantaris muscle responded in a manner similar to that of gastrocnemius, but neither soleus muscle nor liver responded significantly to insulin. These data suggest that corticosterone has two modes of action; one which is independent from and opposite to that of insulin, and a second which causes insulin-resistance through a decrease in sensitivity rather than a change in responsiveness.

The early time course (1, 3, 9, 24 h) of changes in rates of protein synthesis (ks) in liver and three different muscles (gastrocnemius, soleus and heart) was investigated after injection of saline, interleukin-1 beta (IL-1) or turpentine in rats. IL-1 injection induced a consistent increase in body temperature of about 3 degrees C between 3 and 5 h, but thereafter a hypothermic response occurred. With turpentine, a delayed fever response with a peak value by 9 h was observed. Both IL-1 and turpentine had no effect on protein synthesis in the small intestine, but produced a significant increase in ks in the liver at 9 h. By 24 h in IL-1-treated animals, liver ks had returned back to control values, whereas the turpentine-treated group showed a progressive rise in ks. Gastrocnemius and soleus muscles exhibited a significant fall in ks at 9 h after IL-1 and turpentine injection compared with the control. In contrast, the ks of heart muscle increased at 3-9 h after IL-1 injection, but there was no effect of turpentine. Thus for the first time a marked decrease of protein synthesis in skeletal muscle in response to IL-1 could be demonstrated.

We conducted two experiments to evaluate the flooding dose method for measuring intestinal and liver protein synthesis in sheep. Experiment 1 showed that large doses of phenylalanine did not cause marked metabolic disturbances. Experiment 2 examined the effectiveness of flooding with phenylalanine and the time dependency of the protein synthesis calculation. Rams were injected with 1.2 MBq L-[ring 2,6-3H]phenylalanine/kg body wt and slaughtered 20, 40 or 60 min later. Plasma specific radioactivity reached a plateau within 2.5 min and did not change significantly (P> 0.05) throughout the experiment. Tissue intracellular free pool specific radioactivity also remained constant from 20 to 60 min postinfusion. Flooding conditions were achieved in the intracellular free pool of intestinal tissues (specific radioactivity 70–96% of plasma specific radioactivity), although liver flooding was less successful (57–67%). Protein synthesis rates measured after 20 min were significantly (P< 0.05) higher in the liver, jejunum and ileum than those measured at 60 min. Protein synthesis rates also tended to decline with time in the duodenum and colon (P> 0.05). There were no significant differences (P> 0.05) between protein synthesis rates calculated using the intracellular specific radioactivity vs. plasma specific radioactivity in the duodenum, ileum or colon. Therefore, this method represents an improvement over continuous infusion methods for measurements of protein synthesis in visceral tissues.

Currently, there are very few provisions for recycling in theatres. We measured the weight of clinical waste for several orthopaedic operations. This waste was then examined and sorted into domestic waste and clinical waste. With staff education it is possible to reduce the amount of clinical waste generated by the operating theatre by roughly 50%. A greater awareness of disposal options leads to a reduction in waste disposed of by incineration.

Insulin at a concentration close to the physiological range (100 mu-units/ml) stimulated protein synthesis in L6 myoblasts by 17%. Pre-treatment with the phospholipase A2 inhibitors mepacrine or dexamethasone prevented this stimulation and decreased the release of prostaglandin F2 alpha, implicating the action of phospholipase A2 and the subsequent metabolism of arachidonic acid to prostaglandins in the stimulation of protein synthesis by physiological doses of insulin. Higher concentrations of insulin (500-1000 mu-units/ml) stimulated protein synthesis in the presence of mepacrine or dexamethasone, suggesting that an alternative pathway may become important in insulin action when phospholipase A2 is inhibited.

Five patients with the Lambert-Eaton myasthenic syndrome who required more than 48 hours of mechanical ventilation for respiratory failure are described. All five had small cell bronchogenic carcinoma. In one patient with associated chronic bronchitis, one with interstitial pulmonary fibrosis, and one other, respiratory failure requiring mechanical ventilation developed as a result of the Lambert-Eaton myasthenic syndrome. The two other patients had received muscle relaxant drugs, but the acute respiratory failure episode in one of the two was not clearly related to their administration. One patient had an initial response to plasmapheresis, which allowed assisted mechanical ventilation to be discontinued. This improvement was not sustained, and the patient subsequently died in respiratory failure. Three patients survived to be dismissed from the hospital after they were weaned from mechanical ventilation.

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The article reports on Boise State University's preparation for the college gymnastics competition of the National Collegiate Athletic Association (NCAA) in 2018.

Minute ventilation-sensing pacemakers enable the paced heart to respond to an increased workload. Two patients with such a pacemaker developed pacemaker-driven tachycardia when connected to an electrocardiogram (ECG) monitor also capable of documenting ventilatory frequency and ECG lead disconnection. This tachycardia stopped when the ECG leads were removed. These pacemakers and monitors emit a low-amplitude electrical current and measure the resultant impedence signal across the chest. When patients are connected to the monitor the pacemaker sensor summates both impedence signals and the paced heart rate is increased as a result.