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This paper uses case studies of four innovative U.S. midscale food value chains to provide models of how midsized farms and ranches and associated processing, distribution, and retail businesses can prosper by acting collectively to construct a "third tier" in the U.S. agri-food system. Specifically we consider the importance of acting collectively at three distinct levels: horizontally among producers, vertically within food value chains, and horizontally across food value chains. These midscale food value chains represent strategic alliances among midsized farms and other agri-food enterprises that operate at regional levels, handle significant volumes of high-quality, differentiated food products, and distribute profit margins equitably among the strategic partners. From a market perspective, the key advantage of these food value chains is their ability to provide these high-quality, differentiated products that are not available through the mainstream commodity market.

This introductory discussion positions midscale food value chains as business models for a "third tier" in the U. S. food system, distinct from direct marketing to local consumers and global marketing of agricultural commodities. Responding to a growing demand for food that is differentiated from conventional products, midscale food value chains are developing strategic business alliances among small and medium sized farms or ranches and other agri-food enterprises. These supply chain alliances: (a) handle significant volumes of high-quality, differentiated food products; (b) operate effectively at regional, multistate levels; and (c) distribute profits equitably among the strategic partners. Value chain business models place emphasis on both the values associated with the food and the values associated with the business relationships within the food supply chain. Farmers and ranchers are treated as strategic partners, not as interchangeable input suppliers. Midscale food value chains employ two distinct, multifarm marketing strategies: direct-to-wholesale and direct-to-consumer. Both marketing strategies are based on organizational structures that achieve the necessary volumes of high-quality, differentiated food by aggregating product from multiple farms or ranches. The introduction concludes with a discussion of the challenges associated with developing successful midscale food value chains and of needed research and public policies to support the growth of this third tier.

Initiatives intended to create alternatives to the conventional, industrialized, global food system are now emerging. Conceptual framings of alternative food systems have been based principally on the reflections of academics and policy specialists rather than on the views of the producers and eaters who constitute the bulk of the food localization movement. At a conference hosted by the Michael Fields Agricultural Institute, we explored the attributes of food system sustainability with 125 persons representing a broad cross section of the alternative farm/food community. Dividing into five discussion groups, participants were asked what the characteristics of a sustainable food system would be. From their statements we abstracted a set of attributes. Participants envisioned a sustainable food system as relational, proximate, diverse, ecologically sustainable, economically sustaining, just/ethical, sacred, knowledgeable/communicative, seasonal/temporal, healthful, participatory, culturally nourishing, and...

UNLABELLED We compared the efficacy of an adult circle system versus a Bain system to deliver minute ventilation (V(E)) to an infant test lung model using pressure-limited ventilation. To simulate a wide variety of potential infant clinical states, V(E) was measured with two compliances: at peak inspiratory pressures (PIP) of 20, 30, 40, and 50 cm H2O and at respiratory rates (RR) of 20, 30, 40, and 50 breaths/min. Each measurement was made three times, and their average was used for analysis. Data were analyzed using the multiple regression technique. In both normal and low-compliance lung models, V(E) was nearly identical between adult circle and Bain systems (P = 0.67 for normal compliance model, P = 0.89 for low-compliance model). V(E) positively correlated with RR (P < 0.001), PIP (P < 0.001), and lung compliance (P < 0.001). Very high PIP or RR were required to deliver V(E) to the low-compliance lung model. The adult circle system is equivalent to the Bain system in its ability to ventilate an infant test lung over a wide range of RR, PIP, and two compliances during pressure-limited ventilation. V(E) is dependent of PIP, RR, and lung compliance. With low-compliance lungs, both systems require a high PIP. We conclude that both anesthetic systems deliver ventilation over a wide range of respiratory variables during pressure-limited ventilation in infants. IMPLICATIONS We obtained results from this infant test lung study that indicate that either an adult circle breathing system or the Bain system can reliably deliver ventilation over a wide range of respiratory variables during pressure-limited ventilation in infants.

This in vitro study examined the effect of circuit compliance on delivered ventilation (VE) using a time-cycled, volume controlled circle system in an infant lung model. A Bio-Tek ventilator tester set to simulate normal and abnormal lung compliance measured VE delivered by the Narkomed 2B system. Circle circuits of varied compliance (2.75, 1.22 and 0.73 microliters.cm H2O-1) were tested. Tidal volume was adjusted to peak inflation pressures (PIP) of 20, 30, 40, and 50 cm H2O with three circuits, two lung compliances, and four different size tracheal tubes (TT) (2.5, 3.5, 4, 4.5 mm ID). Data were analysed using the multiple regression technique. Delivered VE was directly related to PIP and lung compliance. Delivered VE was not affected by the choice of circuit. TT size had minimal effects on VE when lung compliance was low; TT size was a more important factor when test lung compliance was normal. Extrapolating this data to the clinical setting, adequate ventilation of infants can be achieved with an adult circle system if an appropriate PIP is chosen, regardless of the compliance of the circuit used. Infants with poor lung compliance may require very high PIP for adequate ventilation.

Focusing on the notion of competencies, the address explores important dimensions of human infrastructure for negotiating alternative agrifood systems. The analytical competencies emphasized are those of making connections and evaluating contradictions. Farm structure and food system connections with human health and consumer culture are chosen as examples. Examined in the context of social change strategies, relational competencies focus on new forms of food citizenship involving alternative organizational relationships between farmers, retailers, and customers. Ethical competencies are framed in relationship to the entire food system, to the valuing of non-market goods, and to linkages between ethics and emotions. Finally, aesthetic and spiritual competencies are considered as human capacities to connect agriculture and food with beauty and with sacramental living.

Bioregionalists have championed the utility of the concept of the watershed as an organizing framework for thought and action directed to understanding and implementing appropriate and respectful human interaction with particular pieces of land. In a creative analogue to the watershed, permaculturist Arthur Getz has recently introduced the term “foodshed” to facilitate critical thought about where our food is coming from and how it is getting to us. We find the “foodshed” to be a particularly rich and evocative metaphor; but it is much more than metaphor. Like its analogue the watershed, the foodshed can serve us as a conceptual and methodological unit of analysis that provides a frame for action as well as thought. Food comes to most of us now through a global food system that is destructive of both natural and social communities. In this article we explore a variety of routes for the conceptual and practical elaboration of the foodshed. While corporations that are the principal beneficiaries of a global food system now dominate the production, processing, distribution, and consumption of food, alternatives are emerging that together could form the basis for foodshed development. Just as many farmers are recognizing the social and environmental advantages to sustainable agriculture, so are many consumers coming to appreciate the benefits of fresh and sustainably produced food. Such producers and consumers are being linked through such innovative arrangements as community supported agriculture and farmers markets. Alternative producers, alternative consumers, and alternative small entrepreneurs are rediscovering community and finding common ground in municipal and community food councils. Recognition of one's residence within a foodshed can confer a sense of connection and responsibility to a particular locality. The foodshed can provide a place for us to ground ourselves in the biological and social realities of living on the land and from the land in a place that we can call home, a place to which we are or can become native.

Ten children, aged 1-7 yr, presenting for repair of complex congenital heart lesions, were prospectively studied. A ketamine, halothane/isoflurane, and fentanyl anesthetic was used. After initiation of hypothermic cardiopulmonary bypass, sodium nitroprusside (SNP) was titrated as necessary to maintain a target mean arterial blood pressure of 35-60 mm Hg. Blood samples drawn immediately prior to starting SNP infusion, every 15 min during infusion, and at 1, 4, and 24 h postinfusion were analyzed for whole blood cyanide (CN-) and serum thiocyanate (SCN-). Blood gas analysis was performed every 30 min during SNP infusion. A maximum CN- level > or = 1.0 micrograms/mL was observed in two children; four others had maximum CN- levels between 0.5 micrograms/mL and 1.0 micrograms/mL (normal, < 0.2 micrograms/mL). No child had a clinically important increase of SCN- subsequent to SNP infusion. There was substantial variability in observed CN- accumulation during SNP infusion. CN- levels during the first 60 min correlated with the average SNP rate of administration (P = 0.02). Cyanide levels rapidly decreased after termination of SNP infusion and were undetectable 4 h postinfusion. Despite the short-term increase of CN- level, no child showed biochemical signs of toxicity (acidosis or increased mixed venous oxygen tension).

Hepatic coccidiosis, usually caused by a member of the genus Eimeria, is common in rabbits but rare in other mammals. We describe the first reported case of naturally occurring hepatic coccidiosis in a goat. An approximately 6-month-old crossbred goat was presented with a history of diarrhea for 1 week and death. The liver had grossly visible, coalescing foci of necrosis measuring up to 6 cm in greatest dimension. Microscopically, areas of coagulative necrosis also had ectatic and hyperplastic bile ducts that contained coccidial meronts, macrogamonts, and microgamonts within the cytoplasm of epithelial cells. Bile duct lumina contained scattered oocysts. Fibrosis and aggregates of lymphocytes surrounded affected ducts. Microscopic and ultrastructural characteristics of coccidian stages were compatible with the genus Eimeria, but the species could not be determined. The small intestine also had coccidios])L however, it was unclear whether or not the same coccidian species affected both the liver and the intestine.

Researchers at land-grant universities are under pressure to widen their research objectives, which requires them to expand their inquiry from a disciplinary base to a systems level, to include farmers and nonuniversity organizations as research collaborators, and to communicate with broader sectors of the public, such as consumers and policy makers. However, there are few rewards for scientists who undertake long-term, systems based research. An approach that brings together multidisciplinary, multiprofession teams using a radial model of organization has successfully addressed these challenges in Wisconsin. A small “hub” manages the team, with the remaining participants linked to component taskforces or “satellite” projects. This enables research to be done on both multidisciplinary and related single-discipline questions. Radially organized teams can attract diverse people with different time commitments and reward incentives. The research meets the criteria of public and academic audiences alike. For innovative research and extension efforts like radial teams to reach their full potential, larger institutional changes are needed within the land-grant system and professional agricultural societies.

An understanding of the anesthesiologist's concerns during pediatric plastic surgical procedures can facilitate the coordination of efforts between the multiple services involved in the care of these children. Prior to surgery, the child's history is obtained and physical examination is performed. The condition of the airway is the primary concern. Preoperative medication is usually given by oral routes to avoid injections. Induction intubation, maintenance, and emergence are discussed. Specific postanesthesia care is described. Special precautions are given for children having surgical repair of craniofacial anomalies. Cleft lip and palate and mandibular advancement are described.

Reviews of historical and organizational literature provide the backdrop for a general discussion of citizen input into land-grant universities and for a specific case study: the Citizens Advisory/Oversight Council of the Center for Integrated Agricultural Systems (CIAS) at the University of Wisconsin-Madison. This strong citizens' council, established in 1989, took its form in response to institutionally structured fears among university personnel, on one hand, and farmers and citizen groups on the other. Each group's recognition that the other's concerns were legitimate led to an acceptable resolution. We describe the principal characteristics of the resulting successful CIAS Council that is composed of farmers and representatives of the state's environmental community. Such councils facilitate new approaches to integrating the craft and science of farming, and for linking the production side of agricultural systems with policy issues.

Miller's syndrome is a rare congenital disorder with facial features similar to that of Treacher-Collins syndrome. This report details the anaesthetic management of an infant during multiple surgical procedures, beginning with pylormyotomy at one month of age. Airway management was difficult because of severe micrognathia and was accomplished using an awake intubation with a conventional straight blade modified for continuous administration of oxygen ("oxyscope"). Due to recurrent upper airway obstruction and the anticipated need for multiple surgical procedures in the first years of life, a tracheostomy was placed. Because of the multiple airway, orthopaedic, and nutritional difficulties, it is important that a prospective, multidisciplinary approach be used in these patients' care. Consideration should be given to early tracheostomy for airway maintenance.

This study reports effects of halothane on tumor cells in vitro. Cells from the human colon cancer cell line HT-29 were exposed to various concentrations of halothane for 8-72 h. The effect of this exposure on this colon cancer cell line, with and without coincubation with the biologic response modifier gamma-interferon (IFN-gamma), was studied. Using the tumor target cell survival (TTCS) assay, concentrations of halothane from 0.5 to 2% markedly augmented the antitumor activities of IFN-gamma against HT-29. The tumor cell cytostatic effects of IFN-gamma in the 0.75-6-unit/ml range were increased nearly 400% by concentrations of halothane as low as 1%. These results were confirmed in a separate cytolytic assay (Indium-111 release assay), which revealed that halothane concentrations in the 2-4% range markedly increased the cytolytic capacity of IFN-gamma at doses of IFN-gamma between 75 and 1,250 units/ml. The cytolytic activity of IFN-gamma was increased nearly 300% by doses of halothane as low as 1%. A nearly identical pattern of augmentation of IFN-gamma-induced antitumor activity was observed when the known calmodulin inhibitor trifluoperazine (TFP) was coincubated with IFN-gamma. At concentrations of 4-10 microM, the antitumor activity of IFN-gamma was increased nearly 400%. These observations suggest that the pattern of halothane potentiation of the antitumor activity of IFN-gamma is similar to that exhibited by known calmodulin inhibitors.

Agriculture in the United States today increasingly operates in two separate spheres: large, corporate-connected commodity production and distribution systems and small-scale farms that market directly to consumers. As a result, midsize family-operated farms find it increasingly difficult to find and reach markets for their products. They are too big to use the direct marketing techniques of small farms but too small to take advantage of corporate marketing and distribution systems. This crisis of the midsize farm results in a rural America with weakened municipal tax bases, job loss, and population flight. Food and the Mid-Level Farm discusses strategies for reviving an "agriculture of the middle" and creating a food system that works for midsize farms and ranches. Activists, practitioners, and scholars from a variety of disciplines, including sociology, political science, and economics, consider ways midsize farms can regain vitality by scaling up aspects of small farms' operations to connect with consumers, organizing together to develop markets for their products, developing food supply chains that preserve farmer identity and are based on fair business agreements, and promoting public policies (at international, federal, state, and community levels) that address agriculture-of-the-middle issues. Food and the Mid-Level Farm makes it clear that the demise of midsize farms and ranches is not a foregone conclusion and that the renewal of an agriculture of the middle will benefit all participants in the food system--from growers to consumers. Thomas A. Lyson was Liberty Hyde Bailey Professor of Development Sociology at Cornell University until his death in 2006. He was the author of Civic Agriculture: Reconnecting Farm, Food, and Community. G. W. Stevenson is Senior Scientist with the Center for Integrated Agricultural Systems at the University of Wisconsin-- Madison. Rick Welsh is Associate Professor of Sociology at Clarkson University.

Cancer is second only to trauma as the leading cause of death in children 1-15 years of age. Pediatric cancer patients have unique physiologic, pharmacologic, and psychologic considerations that present a unique challenge to plan anesthesiologist. A thorough understanding of pediatric tumors, along with chemotherapeutics and their complications, is necessary to plan anesthetic management properly. Special attention is directed to the psychologic needs and preparation of both the patient and parents. Close cooperation and coordination among the pediatric oncologist, surgeon, and anesthesiologist are necessary for safe and expeditious operative care.

Summary Background : Anesthesia induction in children is commonly accomplished by introducing volatile agents by mask. Occasionally a child describes an excessive fear of the anesthesia facemask. Little is known of the cause of the fear or of the quality or magnitude of the feelings the child is experiencing. The purpose of this study was to allow children who have established mask fear as demonstrated by volunteering the presence of fear and requesting no mask be placed on the face during the induction of anesthesia and their parents to describe and compare the distress from the mask to the alternative intravenous anesthesia induction. Methods : Eight children describing mask fear on the preanesthetic examination were studied. An Anesthesia Mask Fear questionnaire developed by the investigators was answered by the children and their parents. Results : Six children and their parents completed the study. The age at presentation of mask fear ranged from 1.4 to 14 years. There were one to 16 anesthetic exposures prior to reporting mask fear. One child described an aversion to the odor of the mask. Another boy developed mask fear after a single anesthetic exposure. He was subsequently diagnosed with a generalized anxiety disorder. Four female children developed mask fear after repeated anesthetic exposures. These children rated mask fear with the greatest discomfort possible while venous cannulation was scored at half or less that of the mask discomfort. Conclusions : Care must be taken when developing a plan for anesthesia induction in children requiring multiple procedures. Children may develop an aversion to the odor or feel of the mask, or have a true phobia (irrational fear) of the mask. Those children with a phobia might also have other underlying anxieties.

The authors describe a retrograde fibreoptic technique for tracheal intubation in a micrognathic child with a tracheo-cutaneous fistula.A four-year-old child with Nager's syndrome presented for surgical closure of a tracheocutaneous fistula. A tracheostomy tube had been placed in the neonatal period for management of upper airway obstruction due to severe micrognathia. At 2 1/2 yr of age, after a successful mandibular advancement procedure, the tracheostomy was removed and the child allowed to breathe through the natural airway. Preoperative physical examination revealed an uncooperative child, unable to open her mouth due to limited temporo-mandibular motion. The child was first anaesthetized with ketamine, 70 mg im, then halothane by mask. The authors were unable to open the child's mouth sufficiently to allow rigid laryngoscopy. Attempts at oral and nasal fibreoptic intubation were unsuccessful. Ultimately, the authors were able to intubate nasally by passing an ultrathin Olympus LF-P laryngoscope under direct vision through the tracheocutaneous fistula in a cephalad direction, through the larynx and nasopharynx, then out the nares. An endotracheal tube was then advanced over the fibreoptic scope and positioned distal to the tracheocutaneous fistula. The surgical procedure was successfully accomplished and the trachea was extubated postoperatively without difficulty.Retrograde fibreoptic intubation may be an option for airway management of a select group of children who cannot be intubated by traditional techniques.

We compared the efficacy of a Drager Narkomed GS (North American Drager, Telford, PA) equipped with an adult circle system with two free-standing infant ventilator systems (Servo 300; Siemens Medical Systems, Danvers, MA and Babylog 8000; North American Drager) to deliver minute ventilation (VE) using pressure-limited ventilation to a test lung set to low compliance. To simulate a wide variety of potential patterns of ventilation, VE was measured at peak inspiratory pressures (PIP) of 20, 30, 40, and 50 cm H2O and at respiratory rates (RR) of 20, 30, 40, and 50 breaths/min. Each measurement was made three times; the average was used for data analysis using the multiple regression technique. Delivered V(E) was positively correlated with both PIP (P = 0.001) and RR (P = 0.001). Only minimal differences in VE were observed between the circle and the two free-standing systems. At lower RR and PIP, the Babylog 8000 system delivered slightly higher VE than the circle system, whereas at higher RR and PIP, the Babylog 8000 delivered slightly lower VE than the circle system; these differences in VE were not statistically significant (P = 0.45). The Servo 300 delivered slightly higher VE than the circle system in all test conditions, but these differences were not statistically significant (P = 0.09). None of the differences in delivered VE between the Servo 300 and the circle system are of clinical importance.Our laboratory investigation suggests that pressure-limited ventilation delivered by a standard adult circle system compares favorably with that of freestanding infant ventilators used in pressure-limited mode. Changing from an adult circle system to a free-standing pressure-limited ventilator may not substantially improve ventilation of a low-compliance infant lung; the efficacy of such a practice should be investigated.

The perioperative management of a 16-day-old infant with recurrent supraventricular tachycardia (SVT) is discussed. Vagal manoeuvres and medication were not adequate in controlling the SVT. Since the patient was scheduled for extensive surgery in the prone position, it was decided to use transoesophageal pacing as the method of choice for conversion of SVT. Transoesophageal pacing succeeded several times in overriding the SVT and restoring normal heart rate and haemodynamic variables. The advantages and disadvantages of various methods of treating SVT in the newborn are discussed.

UNLABELLED We examined the efficiency of an adult circle system with adult bellows to deliver minute ventilation (VE) to an infant test lung model. A Narkomed 2B system (North American Drager, Telford, PA) using three modes of ventilator setup were used: A = time-cycled, volume-controlled using bellows excursion to control delivered volume; B = time-cycled, pressure-controlled using inspiratory pressure limit adjustment to control delivered volume; C = time-cycled, pressure-controlled using the inspiratory flow adjustment to control delivered volume. VE was measured with two compliances (normal and low) and four endotracheal tube (ETT) sizes (2.5-, 3.0-, 3.5-, and 4.0-mm inner diameter). VE was measured at peak inspiratory pressures (PIP) of 20, 30, 40 or 50 cm H2O while respiratory rate (RR) was held constant at 20 breaths/min. VE was measured as RR was set at 20, 30, 40, or 50 breaths/min while target PIP was held constant at 20 cm H2O. Data were analyzed using the multiple regression technique. With the low compliance model, VE was nearly identical regardless of the ventilator setup. With the normal compliance model, minor differences in VE were observed, especially at the highest RR and PIP. VE was dependent on RR, PIP, and lung compliance. Overall, the ventilator setup resulted in minor changes in VE. Very high PIPs were required to deliver VE to the low compliance model. ETT size did not affect VE when lung compliance was low; however, smaller ETT size was a factor when test lung compliance was normal, decreasing delivered VE at higher PIP and RR. We conclude that with a Narkomed 2B adult circle system VE is dependent on PIP, RR, and lung compliance, but not on mode of ventilator setup. IMPLICATIONS The results of this laboratory investigation indicate that when an adult circle system is used during infant anesthesia, the ventilation delivered depends primarily on the respiratory rate, peak inspiratory pressure, and the compliance of the lung being ventilated, rather than on the specific mode of ventilator setup.

This in vitro study examined the effect of circuit compliance on delivered ventilation (VE) using a time-cycled, volume controlled circle system in an infant lung model. A Bio-Tek ventilator tester set to simulate normal and abnormal lung compliance measured VE delivered by the Narkomed 2B system. Circle circuits of varied compliance (2.75, 1.22 and 0.73 microliters.cm H2O-1) were tested. Tidal volume was adjusted to peak inflation pressures (PIP) of 20, 30, 40, and 50 cm H2O with three circuits, two lung compliances, and four different size tracheal tubes (TT) (2.5, 3.5, 4, 4.5 mm ID). Data were analysed using the multiple regression technique. Delivered VE was directly related to PIP and lung compliance. Delivered VE was not affected by the choice of circuit. TT size had minimal effects on VE when lung compliance was low; TT size was a more important factor when test lung compliance was normal. Extrapolating this data to the clinical setting, adequate ventilation of infants can be achieved with an adult circle system if an appropriate PIP is chosen, regardless of the compliance of the circuit used. Infants with poor lung compliance may require very high PIP for adequate ventilation.

The flexible ultrathin fibreoptic laryngoscope allows placement of endotracheal tubes as small as 2.5 mm internal diameter. The purpose of this study was to document the safety and efficacy of intubation using an ultrathin fibreoptic laryngoscope. Proved safety and efficacy would justify the routine use of fibreoptic laryngoscopy in normal infants to maintain skills needed for management of the difficult infant airway. In this prospective study, 40 infants < 24 mo of age scheduled for elective surgery were randomly divided into two equal groups. After inhalation induction of anaesthesia, in 20 infants the trachea was intubated using direct rigid laryngoscopy, and in 20 using the ultrathin fibreoptic laryngoscope (size 1.8 mm OD) Olympus LFP. Time to successful intubation was recorded, as well as blood pressure, heart rate, end-tidal CO2 and oxygen saturation. Airway trauma in the operating room, the post-anaesthesia care unit, and on the first postoperative day was recorded. The intubation times using rigid laryngoscopy were less than those using fibreoptic laryngoscopy (13.6 +/- 0.9 sec (mean +/- SEM) vs 22.8 +/- 1.7 sec; P < 0.01). Oxygen saturation and end-tidal CO2 readings were not different between the two groups. After intubation, blood pressure and heart rate increased equally in both groups, returning to normal within one to two minutes. There was no difference in the airway trauma between groups. We conclude that the ultrathin fibreoptic laryngoscope is a safe and effective method for tracheal intubation in infants and may be used routinely in order to maintain fibreoptic airway skills.

Infection of 8-week-old pigs with endemic porcine reproductive and respiratory syndrome (PRRS) virus was detected on a farm that had an epidemic of PRRS in 1989. During the 2.5 years since the original epidemic, reproductive performance of the breeding herd had been within acceptable limits, but mortality had periodically exceeded one-fourth of the pigs in the nursery (195 died of 761 weaned, 25.6%). Investigators attempted to determine the age and humoral immune status of pigs infected with endemic PRRS virus on the farm. Serum obtained from 9 groups of 1- to 18-week-old pigs (10 pigs/group) was examined for PRRS virus by virus isolation. Serum was obtained from 8 sows that had farrowed within the preceding 24 hours. Serum from the sows was obtained weekly until litters were weaned at 3 weeks of age. Serum was obtained from 27 newborn pigs (3 to 4 newborn pigs from each of the 8 sows) prior to intake of colostrum and at weekly or biweekly intervals until the pigs were 20 to 21 weeks of age. Isolation of PRRS virus and indirect fluorescent antibody serologic testing were performed on these serum samples. In another study, serum was obtained for serologic testing from 10 sows in each of 6 parity groups. The PRRS virus was isolated from serum of only 3- to 12-week-old pigs. The 8 sows and their 27 pigs were seronegative for PRRS virus during the 3-week lactation period. By 10 weeks of age, 18 of the 27 suckling pigs were still alive and had seroconverted (titersor = 1:20).(ABSTRACT TRUNCATED AT 250 WORDS)

An understanding of the anesthesiologist's concerns during pediatric plastic surgical procedures can facilitate the coordination of efforts between the multiple services involved in the care of these children. Prior to surgery, the child's history is obtained and physical examination is performed. The condition of the airway is the primary concern. Preoperative medication is usually given by oral routes to avoid injections. Induction intubation, maintenance, and emergence are discussed. Specific postanesthesia care is described. Special precautions are given for children having surgical repair of craniofacial anomalies. Cleft lip and palate and mandibular advancement are described.

Preoperative imaging in patients with potentially resectable liver tumours has traditionally been performed in specialized hepatobiliary centres. To assess the feasibility and value of establishing a same-day, pre-resectional hepatic imaging service, computed tomography during arterial portography (CTAP) and delayed high-dose iodine computed tomography (DICT) were used to examine patients considered suitable for curative hepatic resection. The study group comprised 27 patients (14 from hospitals not affiliated with a university and 13 from two university-affiliated hospitals) for whom pre-referral imaging showed tumour distribution amenable to resection. Among the patients from centres not affiliated with a university, seven had undergone ultrasonography (US) and equilibrium-phase CT, four had undergone US and unenhanced CT, two had undergone equilibrium-phase CT only and one had undergone bolus dynamic incremented CT (BDCT) only. For 12 of the patients coming from the university-affiliated centres, the pre-referral imaging had consisted of US and BDCT; the other had undergone US only. After CTAP and DICT, 20 (74%) of the 27 patients were reclassified as having unresectable disease: 7 (54%) of the 13 patients who had undergone BDCT before CTAP and DICT and 12 (92%) of the 13 patients who had undergone unenhanced or equilibrium-phase CT, as well as the patient who had undergone US only. By averting laparotomy in 20 of the patients, CTAP and DICT resulted in short-term health care savings of about $160,000. These findings suggest that BDCT was underused in the hospitals not affiliated with university centres.(ABSTRACT TRUNCATED AT 250 WORDS)

This paper discusses the imaging methods available for the detection and diagnosis of colon cancer, concentrating on endoscopy and barium radiology. Effective utilization of these two methods may be facilitated by using flexible sigmoidoscopy to direct further investigation. There is a need for educational efforts to enhance the performance of endoscopy and barium radiology so that the high standards achieved in some published series are more generally available to patients. New developments in contrast agents will alter rapidly the roles of ultrasound, CT scanning, and magnetic resonance in the investigation and management of colorectal cancer.

The relation between pyloric motor activity, opening, and closure was examined in eight healthy men. Manometry was performed with an assembly combining 13 side holes and a sleeve sensor positioned astride the pylorus. Simultaneous with manometry, pyloric opening and closure and antroduodenal contractions were observed fluoroscopically with the antrum filled with barium. During intraduodenal normal saline infusion, coordinated antral pressure waves swept over the pylorus and ejected barium into the duodenum. No localised pyloric motor pattern was observed under these conditions. In contrast, the intraduodenal triglyceride infusion was associated with the absence of antral pressure waves and virtual absence of antral wall movement. At the pylorus, there was a zone of luminal occlusion less than 1 cm long that persisted for the period of observation. This zone of luminal occlusion corresponded precisely with manometric recordings of a narrow zone of pyloric phasic and tonic activity. During the duodenal triglyceride infusion, the pylorus was closed for 98.5% of the measurement period when basal pyloric pressure was 4 mm Hg or more, and during this motor pattern, barium did not traverse the pylorus. Localised pyloric contractions cause sustained pyloric closure, whether these contractions are phasic or tonic. These contractions occur independently of antral or duodenal contractions and may interrupt gastric emptying.