Search

Objective: Despite the established guidelines, there is not a clear consensus about how to manage antiplatelet therapy after carotid surgery. It is a common practice in vascular surgery to use the combination of aspirin and clopidogrel in the treatment of such patients. In this work, we analyzed the impact on long-term survival of antiplatelet therapy in patients treated for carotid stenosis at a single institution over a 10-year period., Methods: Outcomes of 471 patients who underwent carotid intervention (1999-2008) were analyzed. Discharge prescription summaries were retrieved, and patients were divided into two groups according to their antiplatelet regimen: aspirin-only group and aspirin plus clopidogrel group. Only patients with a minimum of 30 days of confirmed antiplatelet therapy were included. All-cause mortality during follow-up represented the primary outcome, whereas stroke and bleeding at 30 days and during follow-up represented secondary end points. When local records were sparse, the Social Security Death Index was queried to confirm mortality. The International Classification of Diseases, 9th Revision (ICD-9 codes), was reviewed for treatment related to a bleeding condition., Results: When divided by indication, there was an increased mortality rate in patients with asymptomatic carotid disease receiving dual antiplatelet therapy as compared with aspirin alone (47% vs 40%; P = .05). Patients with symptomatic carotid disease had a nonsignificant decrease in all-cause mortality if they received dual antiplatelet therapy (38% vs 39%; P = .53). In a subgroup analysis, there was a significant increase in the rate of all-cause mortality among patients older than 75 years receiving dual antiplatelet therapy for asymptomatic carotid disease (82% vs 56%; P = .001), whereas there was a nonsignificant decrease in mortality in patients older than 75 years receiving dual antiplatelet therapy for symptomatic carotid disease (47% vs 63%; P = .50). There was no difference in secondary outcomes (stroke and bleeding) regardless of the indication or the antiplatelet therapy., Conclusions: In this retrospective, single-institution study, the use of dual antiplatelet therapy (aspirin plus clopidogrel) in patients intervened for asymptomatic carotid disease was related to increased all-cause mortality, whereas it did not significantly influence the outcome in patients with symptomatic carotid disease., (Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

Background: Lipid-modifying drug therapy (LMDT) is recommended in all patients having coronary or noncoronary atherosclerotic disease. However, the effect of LMDT after abdominal aortic aneurysm (AAA) repair, especially in the absence of other atherosclerotic manifestations, is unclear. We examined the distribution of prevalence of LMDT among patients undergoing AAA repair and its effect on survival in the presence and absence of other atherosclerotic diseases., Methods: We identified patients treated at University of Alabama at Birmingham between 1985 and 2010 who had a prior AAA repair. Information was collected from health system medical charts, medical communication, and national death indices. We assessed the predictors of prevalence of LMDT by univariate analysis using t-test for continuous and χ(2) test for categorical variables, and then performed multivariate logistic regression. The survival was determined using Kaplan-Meier plots, and adjusted hazard ratios were calculated using Cox proportion regression., Results: A total of 2063 patients underwent AAA repair procedure. Of these, 9% were African-American, and 20% were female. Thirty-five percent received LMDT, and 32% died during the follow-up period of up to 240 months. Significant predictors for being on LMDT included white race (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.2), presence of other atherosclerotic disease or diabetes (OR, 2.4; 95% CI, 1.9-3.0), hypertension (OR, 4.0; 95% CI, 3.1-5.2), smoking (OR, 1.6; 95% CI, 1.2-2.1), and endovascular AAA repair (OR, 1.9; 95% CI, 1.5-2.3). LMDT was associated with improved survival (hazard ratio, 0.6; 95% CI, 0.5-0.8) after controlling for traditional risk factors, diabetes, and other atherosclerotic diseases., Conclusions: LMDT after AAA is associated with an increased survival compared with patients who were not using drug therapy for dyslipidemia. Aggressive management of dyslipidemia should be considered in all patients undergoing AAA repair irrespective of other atherosclerotic disease status and risk factor profile., (Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

Objective: To identify risk factors and stratify their effect of compromising 3-year survival in patients treated for asymptomatic carotid disease based upon recently updated guidelines from the Society for Vascular Surgery., Methods: Outcomes of 506 patients who underwent carotid intervention for asymptomatic carotid disease (1999-2008) were analyzed. Hospital computerized medical records were reviewed. When local records were sparse, Social Security Death Index was queried to confirm mortality. Following multivariable Cox regression analysis, a score was assigned based on the calculated hazard ratio (HR) in the following fashion: HR 1.5-1.9 = 1 point; HR 2.0-3.0 = 2 points; and HR >3 = 3 points. The sum of those points comprised the final score for each patient. Kaplan-Meier analyses were then performed to delineate survival differences., Results: Seventy patients (13.83%) did not survive beyond 3 years after the procedure. Age >80 years (HR, 1.79; P = .05; score 1), diabetes mellitus (HR, 1.99; P < .05; score 1), coronary artery intervention (HR, 2.03; P < .01; score 2), severe chronic kidney disease defined as glomerular filtration rate <30 and not on dialysis (HR, 2.46; P = .03; score 2), dialysis patients (HR, 5.67; P = .001; score 3), and chronic obstructive pulmonary disease (HR, 3.53; P < .001; score 3) negatively influenced 3-year survival. Patients with score ≤2 experienced 3-year mortality of 6.0%, whereas score >2 was associated with 31.6% 3-year mortality (HR, 6.10; P < .001). The score value was not associated with the stroke rate at any time point. The resultant score was validated in a separate population of patients with symptomatic carotid disease., Conclusions: This easy predictive score underscores the association of medical risk factors with decreased 3-year survival. This finding may impact future clinical decisions for management of asymptomatic carotid disease., (Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

A group of 97 spring-calving beef cows were initially oestrus synchronised with controlled internal drug release (CIDR) intravaginal progesterone implants inserted for nine days and a prostaglandin injection on day 7. Approximately half the cows were given 10 microg buserelin when the implants were inserted, and they all received a single fixed-time artificial insemination (AI) 56 hours after the withdrawal of the implants. The overall pregnancy rate to the first synchronised AI was 55 per cent, the buserelin-treated cows having a pregnancy rate of 63 per cent compared with 47 per cent in the untreated cows (P>0.05). Sixteen days after the first synchronised AI all the cows were re-implanted with used CIDR implants which were removed five days later, and the cows received a second synchronised AI on days 23 to 24. Cows which received the second AI were implanted with new CIDR devices 16 days later and these were removed after five days and the non-pregnant cows received a third synchronised AI. The pregnancy rates to the second and third synchronised services were 74 per cent and 75 per cent, respectively.

The feasibility of breeding spring-calving, single-suckled beef cows without the use of natural service was investigated over two breeding seasons by using repeated oestrus synchrony and fixed-time artificial insemination (AI). Initially, cows were oestrus-synchronised with subcutaneous norgestomet implants inserted for 10 days, with an injection of prostaglandin before the implants were removed. The cows were inseminated once 56 hours after the implants were removed, and 12 days later they were re-treated with norgestomet implants to allow a second synchronised service. Twenty-one days after the first synchronised AI, milk samples were taken for progesterone assay and the norgestomet implants were removed. The cows received a second service 56 hours later if the 21-day milk progesterone assay suggested that they were not pregnant. All the cows receiving a second service were retreated with norgestomet implants to allow a third synchronised service as necessary. Pregnancy was later confirmed by rectal palpation. In the first year, 48 cows entered the programme and the pregnancy rates to the first, second and third synchronised services were 56, 69 and 40 per cent, respectively, with 17 per cent of cows barren at the end of the breeding period. In the second year, 69 cows entered the programme and the pregnancy rates were 58, 48 and 33 per cent to the successive services with 20 per cent of cows barren at the end of the breeding period. The accuracy of milk progesterone assay for pregnancy diagnosis was 84 per cent and 87 per cent in the first and second years, respectively.

Severe respiratory disease, associated with seroconversion to bovine respiratory syncitial virus (BRSV), caused the death of two cattle and necessitated antibiotic treatment of 70 calves (rectal temperature of 39.6 degrees C or greater) from a group of 96 (73%) during an 8-day period. Tilmicosin injection resulted in a reduction in median rectal temperature from 40.3 degrees C to 39.2 degrees C and 39.0 degrees C for the first and second days after treatment. The rectal temperature was 39.5 degrees C or lower in 72% (48 of 67) and 96% (64 of 67) of cattle 1 and 2 days after tilmicosin treatment, respectively. Ten cattle were re-treated with tilmicosin 6 to 16 days after the first treatment. Our study demonstrated that bovine respiratory syncytial virus infection could cause severe respiratory disease in a beef herd that had no previous history of BRSV-related disease. Secondary bacterial invasion after BRSV infection was controlled effectively by tilmicosin treatment but repeat antibiotic treatments were occasionally necessary due to bacterial re-infection of the respiratory tract.

The purposes of this research were to identify risk factors for reported child abuse or neglect and to examine the roles of stress and social support in the etiology of child maltreatment. Mothers of newborn infants with biomedical and sociodemographic risk factors were recruited from community and regional hospitals and local health departments in 42 counties of North and South Carolina selected for geographic distribution and for large numbers of such newborns. For every four such mothers, the next mother to deliver an otherwise normal newborn was sought. Mothers were interviewed shortly after giving birth, and state Central Registries of Child Abuse and Neglect were reviewed when each infant was 1 year of age. Eight hundred forty-two of 1,111 recruited mothers were successfully interviewed in their homes between March 1986 and June 1987. Seven hundred forty-nine North Carolina births who resided in the state more than 6 months were eligible for inclusion in the analysis. Logistic regression with backward elimination procedures was used in the analysis. Maternal education (p < .01), number of other dependent children in the home (p < .01), receipt of Medicaid (p < .01), maternal depression (p < .05), and whether the maternal subject lived with her own mother at age 14 years (p < .05) were the best predictors of a maltreatment report. Further examination revealed an interaction effect between stressful life events, as measured by life event scores, and social well-being (p < .01). For children born at risk for social and/or medical problems, extreme low income (participation in public income support programs), low maternal education, maternal depression, the presence of any other young children in the home, and a mother's separation at age 14 years from her own mother significantly predict child maltreatment reports in the first year of life. In addition, stressful life events, even if perceived positively, may increase or decrease the risk of maltreatment reports, depending upon the presence of social support.

Twin and single pregnancies were induced in two groups of oestrus-synchronised beef cows by using a combination of artificial insemination and the transfer of in vitro fertilised (IVF) embryos. Single IVF embryos transferred non-surgically to the uterine horn contralateral to the corpus luteum of 43 previously inseminated cows resulted in a calving rate of 72 per cent with a twinning rate of 38.7 per cent. In 45 cows, two IVF embryos were transferred non-surgically to one uterine horn resulting in a calving rate of 51.1 per cent with a twinning rate of 39.1 per cent. The median gestation length for cows bearing twins was 10 days shorter than that of cows bearing single calves (P < 0.001). The proportions of cows that received assistance at calving were similar for twin and single births (57 per cent vs 45 per cent, P > 0.05), but the incidence of retained fetal membranes was much higher after the birth of twins (62 per cent vs 3 per cent, P < 0.001). Nineteen per cent of twin calves were stillborn compared with 6 per cent of single calves (P > 0.05). The median birthweight of the twin calves was 32 kg (68 per cent of the median weight of single calves). The nutrition of twin-bearing cows in late pregnancy was adequate when assessed in terms of their plasma glucose, non-esterified fatty acid and beta-hydroxybutyrate concentrations. Serum immunoglobulin concentrations were similar in single and twin calves suggesting that the passive transfer of antibody was not compromised in the twin calves.

The feasibility of replacing natural service in the suckler herd with artificial breeding (artificial insemination or embryo transfer), following synchronisation of oestrus in breeding animals, was investigated. In 1991 a herd of 143 spring-calving beef cows, matched for date and ease of calving, sex of calf, parity, body condition score and liveweight, were assigned to one of five controlled breeding programmes: natural service (group 1); single oestrus synchronisation using a norgestomet implant and fixed time insemination followed by natural service (group 2); double synchronisation with two consecutive norgestomet implants each with fixed-time insemination followed by natural service (group 3); synchronised as for group 2, but subjected to a movement stress two days after insemination (group 4); and cows synchronised by intravaginal progesterone/prostaglandin regimen with non-surgically transferred in vitro fertilised embryos followed by natural service (group 5). The percentage pregnancy rates to the first and second heats and overall were, respectively: group I, 55.5, 66.7 and 92.6; group 2, 44.4, 71.4 and 89.9; group 3, 52.0, 78.0 and 96.0; group 4, 55.0, 58.3 and 81.5, and group 5, 40.0, 68.2 and 85.7 per cent. In groups 2, 3, 4 and 5 the costs per pregnancy for artificial insemination or embryo transfer were 40.50 pounds, 56.62 pounds, 32.40 pounds and 149.98 pounds, respectively, and the calf weaning weights for groups 1, 2, 3, 4 and 5, adjusted for date of calving, were 250 kg, 255 kg, 252 kg, 261 kg and 259 kg, respectively.

The epidemiology of Nematodirus battus infection under a husbandry system based on an annual alternation of sheep and cattle was studied from 1983 to 1985. Pasture larval levels and sheep and cattle worm egg outputs were monitored from April to September each year. The level of N battus contamination on the sheep pasture and the number of clinically affected lambs increased over the three years despite grazing with cattle in the intervening year. Examination of cattle faeces demonstrated that six-month-old calves excreted moderate numbers of N battus eggs in June and July, thus contaminating next season's sheep grazing.

We examined retrospectively premorbid factors that might relate to the development of irritable bowel syndrome (IBS). We administered a semistructural interview to adult IBS patients, adults with symptoms of IBS who had not visited a doctor (nonpatients), and asymptomatic normals. Patients with IBS differed from nonpatients by reporting more severe bowel problems, more frequent doctor visits in childhood, and more pain associated with current bowel symptoms. These factors may contribute to the tendency of people with bowel symptoms to seek medical care. More patients, and in most cases nonpatients with IBS, reported poorer general health and headaches, stomachaches, and bowel complaints during childhood. They also showed evidence for greater parental attention to illness with more frequent school absences and doctor visits than normal subjects. Loss and separation during childhood, and in the current family, and conflicted or dependent maternal relationships were also more frequently reported among patients and nonpatients. These factors may contribute to the development of IBS.

The potential value of milk progesterone profiles in conjunction with rectal examination in the diagnosis of subfertility in beef suckler cows was investigated. Ten of 20 cows suckled their calves three times per day and the other 10 suckled their calves continuously. Milk samples were collected twice weekly during the 21 days prior to first service and up to day 50 post mating in cows confirmed pregnant. The uterine and ovarian states of the cows were examined per rectum weekly between calving and first service. Progesterone profiles of cows conceiving to first service showed a typical smooth curve, while those of cows failing to conceive were irregular and indicated disturbances in the normal functioning of the corpus luteum.

Profitable suckled calf production, like any other business, depends on the balance between costs and output (Fig 1). The major costs incurred in suckled calf production are feed costs to the cow. Output is simply the weight of weaned calf sold per cow put to the bull, coupled with planned marketing of good quality, cull cows. To maintain this balance at an optimum level requires correct herd management. This can only be achieved with all cows in the herd being at a similar stage of production--a compact two-month calving period. In the long term, a compact two month calving period can only be maintained with correct management of bulling and first-calved heifers. Day-to-day management decisions must be based on the current condition of the cows in relation to the target condition scores set for the system. Understanding this model allows a simple management system to be implemented and achieve the high levels of fertility and suckled calf output required for a profitable enterprise in today's economic climate.

Transluminal angioplasty is being extensively utilized to dilate arteriosclerotic lesions. However, this technique has not been widely used for the treatment of cerebrovascular insufficiency. This report describes the application of transluminal angioplasty to relieve cerebral ischemia secondary to extracranial arterial stenosis. A total of 10 patients presented with symptoms of vertebrobasilar insufficiency. Bilateral upper extremity pressures were measured prior to the performance of arteriography on all patients. Significant stenoses were found in the subclavian artery (9) and in the innominate artery (1). Dilating catheters were passed retrograde through surgically exposed brachial and common carotid arteries. Transluminal angioplasty under fluoroscopic control was attempted. Anatomic correction of all lesions was achieved without hemorrhagic or embolic complications. The mean increase in brachial systolic pressure was 38.2 mm Hg postdilatation. Initial symptomatic relief was total in seven patients, partial in two, and absent in one. It is believed that associated small vessel brain stem disease accounted for the less than total relief of symptoms of these three patients. Average follow-up for all patients was 13 months with one recurrent subclavian artery stenosis occurring at three months postangioplasty. Preliminary results suggest that some patients with cerebral ischemia secondary to extracranial arterial stenosis can be treated safely by transluminal angioplasty.

In this multivariate analysis of the irritable bowel syndrome (IBS) we describe the symptomatic and psychologic features of the condition and their possible contributions to health care seeking. We studied 72 IBS patients, 82 persons with IBS who had not sought medical treatment, and 84 normal subjects. All subjects received complete medical evaluation, diary card assessment of abdominal pain and stool habit, and standard psychologic tests of pain, personality, mood, stressful life events, illness behavior, and social support. Pain and diarrhea were the most important symptoms associated with patient status. When controlling for these symptoms we found that (a) IBS patients have a higher proportion of abnormal personality patterns, greater illness behaviors, and lower positive stressful life event scores than IBS nonpatients (p less than 0.001) and normals (p less than 0.001); (b) IBS nonpatients, although psychologically intermediate between patients and normals, are not different from normals (p less than 0.21); and (c) IBS nonpatients have higher coping capabilities, experience illness as less disruptive to life, and tend to exhibit less psychologic denial than patients. These factors may contribute to "wellness behaviors" among people with chronic bowel symptoms. We conclude that the psychologic factors previously attributed to the IBS are associated with patient status rather than to the disorder per se. These factors may interact with physiologic disturbances in the bowel to determine how the illness is experienced and acted upon.

The time to resumption of ovarian cycles was determined in 27 post partum beef suckler cows by twice weekly milk progesterone analysis and was 24.5 +/ 1.6 (SEM) days. Treatment of 87 cows with a double injection of 500 micrograms cloprostenol at an interval of 11 days resulted in 55 cows (63.2 per cent) responding by a fall in progesterone levels and ovulation. Thirty-eight of these cows (43.7 per cent of total) subsequently conceived to a timed double insemination. Eight (9.2 per cent) had high progesterone levels at the second injection had failed to respond; three (3.4 per cent) had a prolonged period of low progesterone levels after the first injection which were still low when the second was given. A further 21 cows (24.1 per cent) had low progesterone levels at the time of the second injection but could not be categorised further with certainty because of lack of previous samples. These cows were treated at a significantly earlier stage post partum than the rest and in fact were treated earlier than the recommended day 42. However, four of the 21 cows conceived to the timed insemination resulting in a total conception rate of 48.3 per cent.

The influence of time of feeding pregnant beef cows on the timing of parturition was investigated. The results suggest that the distribution of calvings between 'day' and 'night' can be altered by time of feeding. The calculations, based on a small quantity of data, suggest that feeding at 22.00 would result in 79 per cent of cows calving between 06.00 and 22.00. On the same basis of calculation the traditional 09.00 time of feeding would result in 57 per cent of cows calving during the 'day' period. There appears to be some evidence that by feeding pregnant beef cows in the evening better supervision of calving with a smaller proportion of cows calving at night can be achieved.

A total of 16 isolated arterial lesions were dilated intraoperatively in conjunction with primary vascular reconstructive procedures. Of these, eight involved the iliac vessels and eight the femoropopliteal segment. All angioplasties were successful and no catheter-related complications were noted. Hemodynamic improvement was confirmed by intraoperative pressure measurements and/or noninvasive Doppler segmental pressures.