Search

An open trial of transdermal nicotine replacement for smoking cessation was conducted. Over a 7-month period, all patients admitted to the inpatient alcohol and drug treatment unit of the Seattle Veterans Affairs Medical Center, (n = 207) were offered the opportunity to participate in an open trial of transdermal nicotine replacement for smoking cessation. Forty-nine (23.7%) elected to attempt cessation with transdermal nicotine during their inpatient treatment episodes. These subjects received no psychosocial treatments directed specifically at smoking cessation. They smoked a mean of 28.5 (SD = 16.4) cigarettes per day and obtained a mean score of 8.3 (SD = 1.9) on the Fagerstrom Test for Nicotine Dependence. Subjects remained on transdermal nicotine an average of 18.8 (SD = 8.2) days with desire to resume smoking the major reason for discontinuation. Seven subjects (14.3%) self-reported tobacco abstinence at 21 days, and 5 (10.2%) self-reported abstinence as outpatients at 6 weeks. These results show that a substantial proportion of alcohol- and drug-dependent patients entering inpatient treatment are willing to attempt alcohol and illicit drug cessation and tobacco cessation simultaneously and that transdermal nicotine holds promise as a treatment modality in this population.

Mycoplasma bovis was isolated from the tympanic bullae of dairy calves with an exudative otitis media. The history, clinical signs, gross and histologic lesions, and bacteriologic findings are described for 5 preweaned Holstein calves with otitis media from a 600-cow dairy in Michigan. Clinical findings consisted of unilateral or bilateral ear droop, epiphora, head tilt, and recumbency in severely affected calves. Postmortem examination revealed unilateral or bilateral fibrinosuppurative to caseous exudate in the tympanic bullae. Histologically, a marked fibrinosuppurative to caseous exudate filled the tympanic air spaces. The partially ulcerated tympanic mucosa was markedly thickened with mononuclear cell infiltration and proliferation of fibrous connective tissue. Bone remodeling and periosteal hyperostosis were present in some osseous septa. Mycoplasma bovis was isolated from the tympanic bullae of all 5 calves and from the lungs of 2 calves and the frontal sinus of 1 calf. Mycoplasma bovis was isolated at > 100,000 colony forming units/ml from the bulk milk tank of the farm of origin. The isolation of M. bovis from the bulk milk tank, indicating subclinical mycoplasmal mastitis coupled with the feeding of waste milk from mastitic cows to calves is suggestive of a possible source of the infection resulting in otitis media in preweaned dairy calves.

The urofacial (Ochoa) syndrome (UFS) is a rare autosomal recessive disease characterized by congenital obstructive uropathy and abnormal facial expression. The patients present with enuresis, urinary-tract infection, hydronephrosis, and voiding dysfunctions as a result of neurogenic bladders. To map the UFS gene, a genome screen using a combination of homozygosity-mapping and DNA-pooling strategies was performed in 20 selected patients, one patient pool, and three control pools (unaffected relatives). After analyses of 36 randomly chosen markers, D10S677 was identified as being linked to and associated with UFS, as suggested by a significant excess of homozygosity in patients compared with that in unaffected relatives (P < 10(-6)), as well as by the allelic-frequency differences between the patient pool and control pools. Ten additional markers flanking D10S677 and covering a 22-cM region then were analyzed to fine-map the UFS gene by use of haplotype (linkage disequilibrium) analysis. All 31 patients were found to be homozygous for two closely linked markers (D10S1726 and D10S198) located approximately 5 cM telomeric to D10S677, whereas only 12% of the unaffected relatives were homozygous for both markers (P < 10(-19)). Several patients are heterozygous at two markers immediately flanking D10S1726/D10S198, one on the centromeric side (D10S1433) and the other on the telomeric side (D10S603). These recombinational events place the UFS gene near D10S1726/D10S198 and within a 1-cM interval defined by D10S1433 and D10S603 on chromosome 10q23-q24.

Study Objectives: To determine the time above minimum inhibitory concentration (T > MIC) and serum bactericidal activity of five oral cephalosporins against two strains of Haemophilus influenzae., Design: Randomized, crossover study., Setting: University-associated research center., Subjects: Ten healthy volunteers., Interventions: Each subject received a single dose of cefpodoxime 200 mg, cefuroxime 500 mg, cefaclor 500 mg, cefprozil 500 mg, or loracarbef 400 mg each week for 5 weeks. Blood for serum levels was obtained at time zero and 1, 2, 3, 4, 6, 8, and 12 hours after each dose., Measurements and Main Results: Cefpodoxime produced serum concentrations above the MIC for more than 90% of the time for both beta-lactamase-negative and -positive strains of H. influenzae. Moreover, it had serum bactericidal activity for 12 hours against both isolates. Cefuroxime was the second most active cephalosporin, with serum concentrations above the MIC of both isolates for 60% of the time. Cefuroxime provided serum bactericidal activity for 12 hours against the beta-lactamase-negative strain and 6 hours against the beta-lactamase-positive strain of H. influenzae. Even though the T > MIC was less than 50% of the study period for the other cephalosporins, all but cefaclor provided serum bactericidal activity for 12 hours against the beta-lactamase-negative isolate. Cefaclor provided measurable serum bactericidal activity for only 3 hours. The duration of serum bactericidal activity of cefprozil, loracarbef, and cefaclor against the beta-lactamase-positive isolate was 4, 2, and 0 hours, respectively., Conclusion: Cefpodoxime was the most active cephalosporin studied based on T > MIC and serum bactericidal activity against isolates of H. influenzae.

Four experiments were conducted to study the effects of substituting milk chocolate product MCP) for dried whey (DW) on growth performance of starter pigs. In Exp. 1 (4 wk) and 2 (5 wk), 440 pigs (age, 25 d) were assigned to one of four diets: 1) 0% DW + 0% MCP, 2) 20% DW + 0% MCP, 3) 10% DW + 10% MCP, or 4) 0% DW + 20% MCP. Linear reductions (P < .06) in ADG, ADFI, and gain/feed (G/ F) were detected as MCP increased. Replacement of DW with 10% MCP had little effect on ADG or ADFI in Exp. 1, but it reduced them in Exp. 2. In Exp. 3(5 wk), 192 pigs (age, 20 d) were fed one of four complex diets: 1) 15% DW + 0% MCP, 2) 10% DW + 5% MCP, 3) 5% DW + 10% MCP, or 4) 0% DW + 15% MCP. As MCP increased, ADG and ADFI decreased linearly (P < .01), but growth performance was similar between pigs fed the 0 and 5% MCP diets. Experiment 4 was a 14-d preference trial in which the four diets from Exp. 3 and 270 pigs (age, 24 d) were used to make three comparisons: a) diet 1 vs diet 2, b) diet 1 vs diet 3, and c) diet 1 vs diet 4. Pigs consumed between 65 and 77% of their total feed intake as MCP-containing diets (P < .01). In summary, MCP could replace DW at a dietary level of 5% without reducing pig performance, but MCP at dietary levels of 10% or more reduced pig performance. Pigs strongly preferred MCP over DW.

Objective: To evaluate studies that applied Cloninger's tridimensional theory of personality to substance abusers., Methods: Medline and PsychInfo data bases were searched for studies published between 1986 and mid-1995 that used the Tridimensional Personality Questionnaire (TPQ). A supplemental manual search was conducted to identify additional evaluations of the tridimensional theory. Reports were reviewed if they included substance abusers or related tridimensional traits to substance use measures., Results: Factor analyses did not consistently support the tridimensionality of the TPQ. Novelty Seeking (NS) traits distinguished alcoholics from nonalcoholics, Type B and Type 2 alcoholics from their Type A and Type 1 counterparts, smokers from nonsmokers, and individuals (substance abusers and nonabusers) with and without antisocial personality disorder (ASPD). Tridimensional traits independently predicted early onset alcohol abuse and serious delinquency in studies that did not employ the TPQ and were significantly associated with concurrent substance abuse among adolescents. Most studies that compared nonalcoholic youth with positive and negative family histories of alcoholism reported nonsignificant TPQ differences or very small effects. Few alcoholics, cigarette smokers or sons of alcoholics displayed Type 1 (low novelty seeking, high harm avoidance, high reward dependence) or Type 2 (high novelty seeking, low harm avoidance, low reward dependence) TPQ profiles, but rarely were levels of tridimensional traits determined by reference to established norms., Conclusions: NS predicts early onset alcohol abuse and criminality and discriminates alcoholics exhibiting antisocial behavior and persons with ASPD from their nonantisocial counterparts. Findings for the Harm Avoidance (HA) and Reward Dependence TPQ subscales are much less consistent. Some support for the role of elevated HA in intensity of substance use has been adduced. At present, the utility of the TPQ for prevention or clinical purposes is not well established.

Hemolytic E. coli strain 807-13, O149:NM:K88(STb+, LT+), was isolated from the feces of a neonatal diarrheic foal. E. coli 807-13 was examined for adhesion to brush border membranes (BBM) from foals, adult horses and pigs, and its pathogenicity was assessed in neonatal foals and pigs. E. coli 807-13 did not adhere to equine BBM but adhered to pig BBM. It did not cause diarrhea nor did it colonize the intestinal epithelium of 3 colostrum-deprived and 3 suckled foals challenged at 24 h of age. Acute ulcerative gastritis and acute suppurative gastritis were observed in 2 colostrum-deprived challenged foals, and acute neutrophilic enteritis was observed in 1 colostrum-deprived and in 1 suckled challenged foal. No similar histopathologic lesions were detected in the control foals. Both gnotobiotic and suckled pigs developed diarrhea after challenge exposure to E. coli 807-13 and the intestinal epithelium of the pigs was colonized. Histopathologic evidence of gastritis and enteritis among the foals indicated some complicity of E. coli 807-13 in foal enteric disease.

Purpose: We present our experience with repeat surgery for persistent ureteropelvic junction obstruction., Materials and Methods: We retrospectively reviewed the records of patients who underwent pyeloplasty for ureteropelvic junction obstruction between 1984 and 1994, focusing on those who underwent repeat surgery for persistent ureteropelvic junction obstruction after initial pyeloplasty., Results: During the 10-year period 127 pyeloplasties were done by a single surgeon (R. D. W.). Three cases of persistent ureteropelvic junction obstruction occurred in this primary pyeloplasty series (success rate 97.6%). During the same period 9 other patients were referred to us from elsewhere for persistent ureteropelvic junction obstruction after initial pyeloplasty (total 12 patients). Ten patients underwent repeat pyeloplasty with a postoperative stent in place. Two patients needed nephrectomy at the initial repeat procedure and 1 of the 10 repeat pyeloplasty patients ultimately underwent nephrectomy. Six patients who had recurrent ureteropelvic junction obstruction were younger than 6 months at the time of the original pyeloplasty. Excessive urinary drainage was noted in 2 of our 3 cases of failed pyeloplasty. Thus, in 9 patients satisfactory resolution of obstruction was achieved by repeat pyeloplasty (salvage rate 75%)., Conclusions: Persistent ureteropelvic junction obstruction is an uncommon complication after pyeloplasty. Infants who undergo pyeloplasty may be more prone to persistent obstruction after pyeloplasty. Prolonged urinary drainage seems to be a harbinger of persistent ureteropelvic junction obstruction. Careful repeat pyeloplasty with attention to preservation of the blood supply and meticulous watertight anastomosis led to satisfactory resolution of ureteropelvic junction obstruction in 75% of the cases.

Purpose: We report our experience with the management of pediatric urolithiasis during a 10-year period. Our aim was to assess the impact of new technology in the treatment of pediatric urolithiasis., Materials and Methods: We retrospectively reviewed the records of all patients up to age 18 years in whom urolithiasis was treated from 1984 to 1994. In 37 cases 24-hour urine collections were available for metabolic evaluation., Results: A total of 100 pediatric patients was treated for urolithiasis. Mean followup was 36 months. A total of 79 patients underwent 115 procedures for symptomatic urolithiasis and 21 were treated nonoperatively. In 42 patients structural anomalies of the urinary tract required additional management. Metabolic abnormalities in 48 patients included hypercalciuria in 19, defined as greater than 4 mg./kg./24 hours calcium by 24-hour urine collection. Only 24 of the 100 patients had no identifiable predisposing factors. Procedures included shock wave lithotripsy in 42 cases, basket extraction with or without ureteroscopy in 20, percutaneous nephrostolithotomy in 11 and litholapaxy in 12. Open surgery included cystolithotomy in 10 cases and other forms of open lithotomy in 15. Thus, open surgical removal was necessary in 1 of 5 cases., Conclusions: Compared to the traditional mode of stone treatment, fewer patients required open surgery. Our results indicate that a comprehensive approach to the care of pediatric patients with urolithiasis requires attention to metabolic and structural abnormalities.

Two hundred three (40 or 41/treatment, average parity 4.3) Large White x Landrace or Large White x Chester White x Landrace sows were used to determine the valine requirement of sows with a genetic capacity for high milk production. All diets were formulated to contain .90% total lysine, with all amino acids other than valine formulated to be at least 110% of their suggested estimates relative to lysine based on ratios derived from the National and Agricultural Research Councils. The control diet was formulated to .75% total valine, and crystalline valine replaced cornstarch to provide additional treatments containing .85, .95, 1.05, and 1.15% total dietary valine. Corresponding valine:lysine ratios were 83, 94, 106, 117, and 128%. Mean litter size after adjustment was 10.3 pigs across treatments, and average lactation length was 26 d. Number of pigs weaned was not affected by dietary valine (mean = 10.2 pigs), nor was daily sow feed (mean = 6.24 kg) or lysine (mean = 56 g) intake. Valine intake increased (linear, P < .001) as dietary valine increased. Litter weight at d 21 and at weaning (d 26) increased (linear, P < .02) with increasing dietary valine (62.4 to 65.5 kg and 76.1 to 79.9 kg, respectively). Litter weight gain increased from d 0 to 7 (linear, P < .06) and from d 0 to 21 and d 0 to weaning (linear, P < .02) as dietary valine increased. Dietary valine had no effect (P > .10) on sow weight change, 10th rib, or last lumbar backfat change from d 0 to 21 or d 0 to weaning or on days from weaning to estrus. These results demonstrate that increasing dietary valine for high-producing sows (21-d litter weights > 60 kg) results in improved litter weight gain. Based on the linear responses observed, the requirement is at least 1.15% of the diet (72 g/d of valine intake) to maximize litter weaning weight and litter weight gain, much greater than recommended currently by the National Research Council (100% of lysine, 36.5 g/d) or the Agricultural Research Council (70% of lysine, 25.5 g/d).

Purpose: We evaluated our 10-year experience with the surgical treatment of vesicoureteral reflux in uncomplicated duplicated collecting systems., Materials and Methods: Between 1984 and 1994, 54 refluxing renal units (8 bilateral) in 37 female and 9 male patients required surgery. Patient age ranged from 7 months to 17 years (average 4.9 at surgery). Postoperative followup (average 14.2 months) included voiding cystourethrography and renal sonography or excretory urography., Results: Common sheath ureteral reimplantation via an intravesical approach was performed in 48 of the 54 refluxing renal units. Of the remaining 6 renal units detrussorrhaphy was performed in 4, and ureteroureterostomy combined with ureteral reimplantation and partial lower pole nephrectomy were done in 1 each. Two treated renal units had persistent postoperative vesicoureteral reflux, which resolved after subureteral polytetrafluoroethylene (Teflon) injection. No renal had postoperative hydronephrosis. Contralateral reflux was identified in 1 patient who underwent unilateral reimplantation. Our overall success rate was 96% for the surgical correction of vesicoureteral reflux in uncomplicated duplicated collecting systems. Common sheath reimplantation had a 98% success rate., Conclusions: Although a duplicated collecting system increases the risk for surgical treatment, the presence of a duplication anomaly does not adversely affect surgical outcome. Modifications of procedures commonly performed in the surgical treatment of single system reflux to accommodate common sheath reimplantation have excellent surgical results with minimal morbidity.

Native American (NA) veterans have rarely been the focus of investigational efforts. We review studies relevant to an assessment of NA substance-use disorders, and discuss findings of the Drug Abuse Treatment Services Evaluation Project pertaining specifically to NA veterans. A larger proportion of NA veterans discharged from VA inpatient care in FY93 were diagnosed with a substance-use disorder compared to the total population of veterans discharged that year. Substance-dependent NAs were more likely to be diagnosed with alcohol-use disorders and posttraumatic stress disorder, and less likely to be diagnosed with drug-use disorders and other psychiatric disorders than substance-dependent veterans generally.

Alcohol (ethanol) use disorders are prevalent in many countries and are associated with significant social and health costs. Little is known, however, about the comparative cost effectiveness of treatments for alcoholism. Pharmacoeconomic evaluations are largely (if not wholly) absent from the alcoholism treatment outcome database. We discuss pharmacological approaches to the treatment of alcohol withdrawal and dependence, describing agents that ameliorate withdrawal symptoms, deter alcohol consumption, reduce alcohol craving and produce conditioned alcohol aversion. Cost-relevant clinical considerations are elucidated and recommendations for cost-conscious pharmacological treatment of alcohol dependence are proffered.

Serotype, biotype, antibiogram, hemolysin production, fimbrial hemagglutinins, select toxin genes (STb, STaP, LT, slt1 and slt2) and the attaching effacing (eae) gene were determined for 99 foal strains of E. coli. E. coli from diarrheic and normal foals could not be distinguished by serotype, biotype, or antibiogram. Differences (P < or = 0.05) were observed in hemolysin production (11.5% vs 0%) and the expression of mannose-resistant hemagglutinins (23% vs 13%) among E. coli from diarrheic and healthy foals, respectively. Three of the E. coli strains from diarrheic foals were positive with probes for slt genes and one was positive for STb and LT genes. One strain from a healthy foal possessed the STb gene. As determined by the polymerase chain reaction, 8 strains possessed the eae gene. Seven of the 8 strains were from diarrheic foals and one eae-positive strain was from a healthy foal. The slt-positive strains did not possess eae genes and the eae-positive strains did not possess slt genes. These results indicate that enterotoxigenic strains of E. coli are not implicated in any substantial degree in sporadic foal diarrhea. However, the identification of slt-positive and eae-positive strains in foal feces indicate the presence of potentially virulent strains among foals.

Empirical studies of American Indian health and mental health have focused primarily on reservation samples or small cross-sectional school-based or treatment samples. Few studies have addressed these issues among urban American Indian populations. This paper introduces an ongoing ten-year prospective longitudinal study of alcohol abuse, drug abuse, and mental health status in a community sample of urban American Indian adolescents and women. The study uses structured interviews and diagnostic assessments to identify risk factors for, and measure prevalence of, alcohol abuse, drug abuse, and psychopathology in 523 Indian youth and 276 Indian women. Study aims, rationale, research design, methods, sample characteristics, assessment instruments, and substance use prevalence are described, and methodological issues related to conducting longitudinal research are discussed.

Methodological characteristics and substantive findings of investigations of essential and reactive alcoholics were reviewed. The data base was comprised of approximately 12 studies published between 1951-1992, most of which employed small samples of hospitalized male alcoholics. Psychometric properties of the Essential-Reactive Alcoholism Questionnaire, the instrument generally used to assess the essential-reactive dimensions, rarely were examined. The weight of the evidence suggests that essential alcoholics have earlier onset and greater severity of alcoholism, lower levels of occupational and educational achievement, more interpersonal conflict, fewer long-term friendships, more antisocial attitudes and conduct, greater density of familial alcoholism, more impaired neuropsychological functioning, and lower resting blood pressure than do reactive alcoholics. Research is needed to assess the prognostic utility of the essential-reactive typology and the degree to which the distinction may facilitate patient-treatment matching.

Reported here are findings from a randomized community intervention trial that followed 90 recovering alcoholic smokers for 6 months. Because the brief (10-min) study intervention had no effect on tobacco use, intervention and control participants were pooled to identify predictors of attempts to quit smoking that may inform clinical practice. During the first 6 months after discharge from residential alcohol treatment, 31% of all participants reported having quit smoking for 48 hrs or longer. Demographic and drug use history variables did not predict quit attempts, but two baseline tobacco use variables did, specifically the Fagerstrom Test for Nicotine Dependence and stage of readiness to quit smoking, p < .01. Participants with high or very high nicotine dependence scores were significantly less likely than those with moderate or low scores to attempt smoking cessation. Compared to those in precontemplation at baseline, those in the preparation stage of readiness to change were about 12 times more likely to make a serious quit attempt.

Demographic, diagnostic, and service utilization characteristics of veterans diagnosed with suicide attempt, substance dependence, both, or neither at discharge from Department of Veterans Affairs (DVA) hospitals in fiscal year 1994 (FY94) were compared using the DVA's discharge abstract database. Four groups of veterans were studied: (1) substance-abusing suicidal inpatients (n = 1,459), (2) substance-abusing nonsuicidal inpatients (n = 123,808), (3) nonsubstance-abusing suicidal inpatients (n = 632), and (4) nonsubstance-abusing nonsuicidal inpatients (n = 402,906). Substance-abusing suicidal veterans had higher rates of substance abuse than substance-abusing nonsuicidal veterans. Substance-abusing suicidal veterans had a higher mean number of inpatient treatment episodes and a larger proportion of discharges against medical advice than the other three inpatient groups. Psychiatric and substance use disorders are more prevalent among substance-abusing suicidal veterans than among veterans with only substance use disorders or suicidal conduct.

Objectives: The study examined the prevalence of substance use, psychiatric, and medical disorders in female veterans discharged from VA hospitals., Methods: The VA discharge abstract database was used to identify women discharged in fiscal year 1991 who received a diagnosis of substance abuse or dependence or substance-induced psychosis (N = 1,698). They were compared with female veterans who did not receive a substance-related diagnosis (N = 12,037)., Results: Alcohol and cocaine use disorders were the most prevalent substance use disorders. Women with substance use disorders were more frequently diagnosed as having personality disorders, depression, and posttraumatic stress disorder than women without substance use disorders. Skin and subcutaneous tissue diseases, infectious and parasitic diseases, and digestive diseases were more prevalent among women with substance use disorders than among women in the same age group who did not have substance use disorders. Approximately 44 percent of women with substance use disorders who were discharged during the first six months of fiscal year 1991 were rehospitalized within that year., Conclusions: Substance use disorders and associated comorbidities are endemic among women treated in VA hospitals. Additional studies examining characteristics of indigent women with substance use disorders are needed.

We extended the principles of the onlay flap to the most severe hypospadias cases. Four patients with perineal hypospadias required central division of the urethral plate to correct chordee despite dorsal plication. The urethra was reconstructed in 1 stage by proximally and distally onlaying to the remaining urethral plate a flap with its central portion tubularized to fill the gap where there was no longer a urethral plate. All patients have good cosmetic and functional results at 1 year of followup. There were no strictures or diverticula but 1 fistula developed. This technique extends the principles and advantages of an onlay flap to those severe hypospadias cases that require division of the urethral plate to correct chordee.

We describe an operation that increases bladder neck resistance in patients with urinary incontinence. It is a modification of the rectus fascial sling that was designed as an adjunct to augmentation cystoplasty and is used in association with clean intermittent catheterization. The operation is performed by circumferentially wrapping a rectus fascial defatted free graft around the bladder neck and suturing it to appose the bladder neck. The procedure was done in 17 patients, including 10 with myelodysplasia, 3 with sacral lipoma, 3 with bladder exstrophy and 1 with nonneurogenic neurogenic bladder. Leak point pressure improved in patients in whom it was measured preoperatively and postoperatively. Complications developed in 5 patients, including difficulty with catheterization in 2, ventral hernia at the graft harvest site in 1, bladder calculus in 1 and detrusor hyperreflexia in 1. Early results with the bladder fascial wrap indicate that it has the ability to improve continence in patients with a dysfunctional bladder neck who have undergone augmentation.

We describe a stone occurring in a bladder augmented with stomach. The stone was composed of uric acid, the expected mineral component in an acid medium.

Once-daily administration of aminoglycosides may be a safe and effective therapeutic regimen, on the basis of the microbiologic and pharmacokinetic characteristics of these antibiotics. This study was designed to determine serum and tissue concentrations following i.v. administration of gentamicin, at dosages of 6.6 mg/kg of body weight, every 24 hours, and 2.2 mg/kg, every 8 hours, for 10 days in adult horses. Nephrotoxicosis from these dosage regimens also was compared, and microbiologic effects, including postantibiotic effects, were determined with various concentrations of gentamicin against an equine clinical isolate of Pseudomonas aeruginosa. Treatment at the 6.6-mg/kg dosage resulted in maximal serum concentrations (77.93 +/- 19.90 micrograms/ml, mean +/- SEM) and area under the concentration-vs-time curves (83.79 +/- 14.97 micrograms.h/ml) that were significantly (P < 0.05) greater than those following treatment at the 2.2-mg/kg dosage (5.05 +/- 0.50 micrograms/ml and 6.03 +/- 0.66 micrograms.h/ml, respectively). Nephrotoxicosis was not induced with either dosage regimen, and postantibiotic effects were prolonged with a higher gentamicin concentration. This study provided evidence to support the use of once-daily gentamicin treatment in adult horses.

Dust generation from swine feed (corn-soybean meal diet) treated with soybean oil was investigated using a cement mixer in a plywood box. Airborne total dust concentrations in the box were measured gravimetrically using a vacuum pump and filters while 12-kg feed samples were constantly mixed. The treatment factors were soybean oil concentration (0, 1, and 3%), corn bulk density (normal, 730 kg/m3 and low, 600 kg/m3), time of oil addition (before vs after grinding the corn), and storage time (0, 7, and 14 d). The feed was a mixture of soybean meal, base mix, and adjusted amounts of ground corn and soybean oil. Adding soybean oil after grinding at 1 and 3% levels to feed made with normal-bulk density corn suppressed total dust generation (3.39 and .99 mg/m3, respectively) (P < .001) compared with the no oil treatment (29.1 mg/m3). The 3% soybean oil treatment suppressed dust generation (.99 mg/m3) more than the 1% soybean oil treatment (3.39 mg/m3) (P < .001). Adding soybean oil after grinding the corn suppressed dust generation more than adding the oil to the corn before grinding for every oil level (P < .001). More dust was generated by feed made from low-bulk density corn than by feed made with normal-bulk density corn at every oil level (P < .001). There was no evidence of any storage time or treatment x storage time interactions.

Consensually established principles of clinical conduct, known variously as practice guidelines, standards, protocols, or algorithms, have proliferated throughout medicine over the past decade. Institutional and disciplinary efforts to develop and promulgate guidelines for the treatment of additive disorders have recently been initiated. We review guideline development activities of the American Psychiatric Association, American Psychological Association, American Society of Addiction Medicine, American Nurses Association, National Association of Social Workers, and Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration. Medical care performance and outcome assessments are discussed with attention to the role they can play in evaluating and refining guidelines. Potential effects of guidelines, salutary and deleterious, on clinical practice in the addictions are delineated.

Prescriptive standards of clinical conduct--practice guidelines--have proliferated throughout medicine over the past decade. Practicing physicians are confronted with a plethora of guidelines developed for different purposes by a diverse body of public and private organizations. We review factors contributing to the growth of guidelines, their desirable features, and consequences, legal and otherwise, of implementing guidelines. Few studies have examined whether, and under what conditions, guidelines are effective in changing physicians' practices and patients' health. Nonetheless, expectations for guidelines remain high because they are one of the only instruments of health care reform that promises to improve the quality of care while reducing overall health care costs. Efforts to develop guidelines are likely to continue unabated for the foreseeable future. Additional research comparing different methods of developing and disseminating guidelines is needed.

A low ventilation model to induce ascites was introduced and characterized. In addition, the effect of supplemental air mixing via ceiling fans (CF) and the feeding of a urease inhibitor (0, 125, and 250 ppm) on incidence of ascites were investigated. Twelve environmental chambers were utilized in the trial; six were fitted with CF. Each dietary treatment was replicated twice per CF treatment. One hundred and twenty day-old male commercial broilers were reared per chamber. Atmospheric O2, CO2, and NH3, temperature, and humidity, as well as weekly litter moisture and pH, were monitored. Chamber CO2 levels increased immediately then stabilized. Chamber NH3 levels increased between 2 to 4 wk of age and rapidly declined when ventilation rates were increased to 1 cfm per bird. The CF and dietary treatments had little effect on air or litter variables except for NH3. Supplementing the diet with urease inhibitor resulted in a greater than 50% reduction in cumulative mortality due to ascites and a slight reduction in weekly BW gains. The CF treatment had no effect on production variables such as weekly feed intake, gain, and feed to gain ratio, or survivability due to ascites.

Restricted ventilation was used to experimentally induce ascites in commercial male broilers. The role of a dietary urease inhibitor (0, 125, and 250 ppm) and ceiling fans to reduce ascites was investigated. At 6 wk of age, birds were bled, euthanatized, weighed, scored for ascites, and heart, liver, and small intestine weights were obtained. Random samples were analyzed for intestinal ammonia. Blood samples were analyzed for blood gases, hemoglobin, red blood cell count, blood urea nitrogen, ammonia, and uric acid. Birds fed 125 and 250 ppm urease inhibitor were significantly (P < .001) lighter at 6 wk, when compared with controls. Urease inhibitor (125 and 250 ppm) significantly decreased large intestine ammonia. Urease inhibitor significantly increased small intestine (250 ppm) and liver weights (125 and 250 ppm), whereas urease inhibitor at 125 ppm decreased right ventricular heart weight. Urease inhibitor had no effect on ascites scores, blood gases, or blood ammonia, but hemoglobin, blood urea nitrogen, red blood cell count, and uric acid were significantly (P < .05) decreased by 125 ppm urease inhibitor.

Objective: The authors examined patterns of substance use disorders and psychiatric and medical comorbidity in all male veterans treated in Veterans Affairs (VA) medical centers during a one-year period., Methods: A national discharge abstract data base was used to derive point prevalence rates of psychiatric and medical disorders for 539,557 inpatients treated in VA medical centers in fiscal year 1991., Results: Nearly one-quarter of all male veterans treated in the study year had a substance-related diagnosis. The most prevalent substance use disorders were alcohol dependence (87.7 percent) and cocaine dependence (17.5 percent), and the most frequent psychiatric diagnoses among veterans with substance-related diagnoses were depression and personality disorders. Digestive disorders were more prevalent among veterans who abused substances than among veterans who did not, and veterans who abused substances were also more likely to have multiple hospitalizations and longer index hospital stays., Conclusions: Substance use disorders and comorbid psychiatric syndromes are common in male veterans treated in VA hospitals. Veterans with substance-related diagnoses may have longer hospital stays and more frequent hospitalizations than veterans without substance use disorders.

Demographic, clinical, and treatment episode characteristics of 3,087 American Indian veterans discharged from Department of Veterans Affairs hospitals in fiscal year 1991 were examined. Substance use disorders were diagnosed in 46.3 percent of discharged American Indians, compared with 23.4 percent of discharged veterans overall. More than 97 percent of American Indian substance use diagnoses were for alcohol dependence, while rates of other drug use disorders were low. Substance dependent American Indians were younger, and more likely to be male and unmarried, than nondependent American Indians. Psychiatric disorders, particularly personality disorders, depression, and posttraumatic stress disorders, were more prevalent among American Indians diagnosed with substance use disorders, than among nondependent American Indians. American Indians with substance use disorders were similar demographically to the general population of substance dependent veterans. Rates of diagnosed psychiatric disorders and drug dependencies other than alcohol were lower among American Indians receiving substance (alcohol or drug) use diagnoses than among the general population of substance dependent veterans. Rates of rehospitalization following discharge were higher in substance-abusing American Indian veterans than among their counterparts. Potential explanations for these findings are discussed.

The Department of Veterans Affairs is the largest provider of drug dependence treatment services in the United States. However, a national evaluation of primarily drug-dependent veterans has never been reported. Findings from the Drug Abuse Treatment Services Evaluation Project, a three-year investigation of drug dependence treatment within the Department of Veterans Affairs, are discussed. Demographic and diagnostic data are presented for the population of 46,047 inpatients discharged with drug dependence diagnoses in Fiscal Year 1991. Patient subtypes and clinical issues of growing relevance to the treatment of drug-dependent veterans are discussed.

Obsessive compulsive disorder (OCD) is now recognized as a relatively common disorder that often has its onset in childhood. Both behavior modification and newly available serotonin reuptake inhibitors have shown to be beneficial in reducing the primary symptoms of OCD in adults, but behavior therapy has not been well-studied in children. This paper presents a case of a 13-year-old boy admitted to a child psychiatric inpatient service with severe OCD, psychotic features, and a history of Tourette's syndrome. The integration of standard behavior therapy techniques on a child inpatient service and barriers to implementing these techniques are discussed.

Enrofloxacin was administered orally to 6 healthy dogs at dosages of approximately 2.75, 5.5, and 11 mg/kg of body weight, every 12 hours for 4 days, with a 4-week interval between dosage regimens. Serum and tissue cage fluid (TCF) concentrations of enrofloxacin were measured after the first and seventh treatments. The mean peak serum concentration occurred between 1 and 2.5 hours after dosing. Peak serum concentrations increased with increases in dosage. For each dosage regimen, there was an accumulation of enrofloxacin between the first and seventh treatment, as demonstrated by a significant (P = 0.001) increase in peak serum concentrations. The serum elimination half-life increased from 3.39 hours for the 2.75 mg/kg dosage to 4.94 hours for the 11 mg/kg dosage. Enrofloxacin accumulated slowly into TCF, with peak concentrations being approximately 58% of those of serum. The time of peak TCF concentrations occurred between 3.8 hours and 5.9 hours after drug administration, depending on the dosage and whether it was after single or multiple administrations. Compared with serum concentrations (area under the curve TCF/area under the curve serum), the percentage of enrofloxacin penetration into TCF was 85% at a dosage of 2.75 mg/kg, 83% at a dosage of 5.5 mg/kg, and 88% at a dosage of 11 mg/kg. All 3 dosage regimens of enrofloxacin induced continuous serum and TCF concentrations greater than the minimal concentration required to inhibit 90% (MIC90) of the aerobic and facultative anaerobic clinical isolates tested, except Pseudomonas aeruginosa.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol exerts several of its actions via the chloride channel associated with the central GABA-benzodiazepine receptor complex. To explore a possible role for this receptor complex in risk for alcoholism, and to determine whether risk for alcoholism is associated with risk for benzodiazepine abuse, the authors administered intravenous diazepam to 18 sons of male alcoholics (SOAs) and 18 control subjects. Four logarithmically increasing doses of diazepam and matched volumes of placebo were given in randomized order on separate days about 1 week apart. SOAs were significantly more likely than controls to report euphoric responses to diazepam. At some diazepam doses, SOAs were more likely to report feeling "high" and "intoxicated." SOAs and controls did not differ in feeling "drugged." SOAs and controls may differ in expectations regarding the subjective effects of drugs and/or in the function of the central GABA-benzodiazepine receptor complex. These findings also add further evidence for increased pleasurable effects, and thus possibly increased risk for benzodiazepine abuse, in a subgroup of SOAs.

A total of 87 patients in the United States underwent surgical correction of vesicoureteral reflux as part of the International Reflux Study in Children. Of the 66 patients randomized to surgical treatment 2 were transferred to the medical group before surgery was performed, while 23 patients originally assigned to receive medical management ultimately underwent surgery. Of the patients 17 (20%) were less than 1 year old, while the remaining children were evenly distributed by age in 2-year intervals up to age 9 years. Reimplantation was performed by the Cohen technique in 52% and by the Politano-Leadbetter technique in 28% of the patients. Bilateral reimplantation was done in 70 patients (80%). The results were satisfactory, with no obstructions. In 81% of the patients average followup was 3.9 years, although followup of less than 1 year in 19% was satisfactory to determine obstruction. Only 3% of the children were lost to followup. Postoperative reflux, which was noted in 5 patients, resolved in all but 1 ureter. These results reflect the experience of senior surgeons in pediatric urology.

Ceftiofur is a new broad spectrum cephalosporin marketed for the treatment of acute bovine respiratory disease. In this investigation ceftiofur was administered by intramuscular injection, at 24 h intervals, to healthy beef-bred calves for four days at dosages of 2.2 and 4.4 mg/kg of body weight, with 4 wk intervals between dosing regimens. Serum, tissue chamber fluid (TCF), and bronchial secretion (BS) concentrations of ceftiofur were measured by microbiological assay after the first and fourth dose of each dosing regimen. Peak serum concentrations (Cmax) of 8.8 micrograms/mL and 17.3 micrograms/mL were obtained approximately 2 h (Tmax), the time of mean peak concentration) after single injections of 2.2 mg/kg and 4.4 mg/kg, respectively. The Cmax was increased approximately twofold following multiple doses of 2.2 mg/kg (Cmax = 13.1 micrograms/mL) and 4.4 mg/kg (Cmax = 24.1 micrograms/mL). Ceftiofur accumulated slowly into TCF and peak concentrations were found to be approximately 14% of those observed in serum after the first dose and approximately 24% after multiple dosing. Concentrations of ceftiofur in BS were obtained rapidly with peak concentrations reaching 45% of the serum Cmax after the first dose. After multiple dosing the Cmax for BS was approximately 25% of the serum Cmax. This study found that both the 2.2 mg/kg and 4.4 mg/kg dosing regimens resulted in continuous serum, TCF and BS concentrations of ceftiofur that exceeded the minimal concentration required to inhibit the bacteria most frequently isolated from calves with acute bovine respiratory disease.

Serum retinol, retinyl palmitate, and total vitamin A concentrations, and jejunoileal morphology were examined in neonatal calves infected with Cryptosporidium parvum. Group-1 calves served as noninfected controls and, after an adjustment period, were given 50 ml of saline solution i.v. every 12 hours for 6 days. Group-2 calves were inoculated with 10(7) C parvum oocysts and, after the onset of diarrhea, were given 50 ml of saline solution i.v. every 12 hours for 6 days. Group-3 calves were inoculated with 10(7) C parvum oocysts and, after the onset of diarrhea, were treated with difluoromethylornithine (DFMO, 200 mg/kg of body weight i.v., q 12 h) for 6 days. Group-4 calves were naturally infected with C parvum. Jejunoileal biopsy specimens were excised from calves of groups 1-3 at 3 and again at 15 to 16 days of age. During the course of diarrhea and 3 days after saline or DFMO administration, water-miscible retinyl palmitate was administered orally (2,750 micrograms/kg) to each calf in each group. Cryptosporidium parvum infection was associated with significant (P < or = 0.05) reduction in postadministration serum retinol, retinyl palmitate, and total vitamin A concentrations in calves of groups 2, 3, and 4. Cryptosporidium parvum infection caused significant (P < or = 0.05) reduction in villus height. Decreased villus height, villus blunting and fusion, and attenuation of the intestinal mucosa were associated with reduced absorption of vitamin A, as indicated by lower peak postadministration retinyl palmitate concentration in C parvum-infected calves. Intravenous administration of DFMO to group-3 calves did not improve retinol absorption.(ABSTRACT TRUNCATED AT 250 WORDS)

Injectable polytetrafluoroethylene (Teflon) and collagen have inherent problems that may prevent their long-term success. In search of a different injectable biomaterial we confirmed in rabbits the safety of injected Bioglass particles suspended in sodium hyaluronate. A second study was performed testing the ability of the Bioglass suspension to increase urethral resistance in pigs. Bioglass particles in suspension have the potential to substitute for polytetrafluoroethylene or collagen in the treatment of urinary incontinence or vesicoureteral reflux.

Ceftiofur sodium was evaluated as a therapy for respiratory infections in horses. This cephalosporin antimicrobial was administered intramuscularly every 24 h and at a dose of 2.2 mg/kg (1.0 mg/lb) of body weight. The efficacy of ceftiofur sodium was compared with that of a positive control drug, ampicillin sodium (recommended dose of 6.6 mg/kg [3 mg/lb], given every 12 h). Both treatments were continued for 48 h after clinical symptoms were no longer evident (maximum of 10 days). Fifty-five (55) horses with naturally acquired respiratory infections were included in the study; 28 were treated with ceftiofur and 27 with ampicillin. Clinical improvement was recorded for 92.9% of the patients treated with ceftiofur and 92.6% of the animals receiving ampicillin. Both therapies reduced body temperatures to an afebrile level after 2 days of treatment. Complete recovery/cure was noted for 78.6% of the ceftiofur patients and 59.3% of the horses treated with ampicillin. Supporting variables (depression/malaise, respiration/dyspnoea, nasal discharge) were assessed and these also substantiated the effectiveness of the treatments. Both antibiotics were well tolerated. Neither pain nor swelling were noted at the ceftiofur injection site(s). None of the animals developed diarrhoea. Data from this study indicated that ceftiofur sodium is an effective and safe treatment for respiratory infections in horses.