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Objectives:The National Confidential Enquiry into Patient Outcome and Death presents a detailed survey of practice, encompassing the care pathway for patients with a new tracheostomy formed in hospital, alongside a review of organisational aspects of care.Results:Tracheostomy formation has come to be regarded as a relatively low-risk procedure that can be carried out safely at the bedside, even in high-risk patients. Information on how many procedures are carried out percutaneously has been poor and not captured by existing UK data collection systems.Conclusion:The study reinforces recommendations made by other healthcare groups, and presents new information which can be used as a basis for discussion and future planning to improve patient outcomes. The importance of meticulous ongoing care of a tracheostomy is recognised as important to prevent patient complications. Bedside staff must have the knowledge, competencies and confidence to deal with common and potentially life-threatening emergencies when they occur.

Since vital staining has been advocated as a sensitive method of displaying epithelial atypia, 14 oral squamous cell carcinomas were stained immediately preoperatively with toluidine blue and then resected 1 cm outside clinically abnormal or positively staining tissue. The integrity of the entire tissue margin was histologically examined in each case. Whilst vital staining delineated all 14 invasive carcinomas at the centre of each resected specimen, 10 foci of carcinoma-in-situ or severe dysplasia were identified not to have stained at the resection margins. Toluidine blue may, therefore, be an adjunct in identifying invasive tumour at mucosal resection margins. However, it would appear to be of no benefit in delineating positive resection margins due to carcinoma-in-situ or severe dysplasia, and hence it may be of little value in reducing the incidence of local recurrences.

To determine the sonographic dimensions and an imaging protocol for the pyloric region of the normal canine stomach, and whether sonography could be used to demonstrate antroduodenal motility.20 clinically normal, mixed-breed dogs (mean +/- SD, 15.1 +/- 7.1 kg).In vitro sonographic observations of the gastroduodenal junction were made after each had been mounted on an acrylic rack placed in an organ bath. The in vivo studies were performed in anesthetized dogs.The wall of the pyloric antrum was 4 to 5 mm thick, that of the pylorus was 3 to 4 mm thick, and that of the cranial part of the duodenum was 2 to 3 mm thick. The pyloric canal had a length of 16 to 17 mm and overall in vivo diameter of 22 mm, and the muscular part of its wall was 2 to 3 mm thick. In vivo sonographic images were best made with the dog in dorsal recumbency, tilted 30 degrees to the right-the feasibility study clearly demonstrated the form and function of antroduodenal motility, including gastric and duodenal peristalsis, opening and closing of the pyloric canal, and duodenogastric reflux of fluid and gas.The use of a routine imaging protocol, accompanied by mensuration of the gastroduodenal junction, will permit an opinion to be given as to whether the structure and function of the region are normal or whether pathologic change exists.

Results of radiologic and anatomic studies of each cubital articulation (elbow) of a group of 50 adult cat cadavers indicated that a sesamoid bone may be located in a constantly present sesamoid cartilage associated with the tendon of origin of the supinator muscle. Radiography revealed a sesamoid bone in 40 of the 100 tendons of origin of the supinator muscles dissected from the elbows. The sesamoid bone articulated with the craniolateral aspect of the head of the radius, and the larger sesamoid cartilage, which contained the bone, articulated with the head of the radius and the capitulum of the humerus. Of several possible functions of the sesamoid cartilage (bone), it was considered that protection of the craniolateral part of the humeroradial articulation and maintenance of the complex anatomic system during joint movement were important. In radiographic views of the elbows of lame cats, the sesamoid bone should not be mistaken for a chip fracture or an osteocartilaginous loose body.

The ultrastructure of cells of the seminiferous epithelium is described in both triploid ZZZ and ZZW fowls, especially cytological aberrations influencing the development of morphologically abnormal spermatids and spermatozoa. Mitotic divisions in triploid fowls are similar to those in diploid fowls, but meiosis in both the ZZZ and ZZW triploid fowl is abnormal and many defective gametes are produced. The majority of spermatids have structural abnormalities and this is attributed to the aneuploidy expected from meiotic chromosome pairing in a triploid. Some spermatids were observed to possess an irregularly shaped head, 2 centriolar complexes, 2 acrosomes and 2 tails and this type differentiated into large-headed spermatoza. Such spermatids and spermatozoa are suggested to be near diploid due to their large nuclear size and 2 sets of organelles. Other spermatids, observed with only 1 centriolar complex, 1 acrosome and 1 tail, are suggested to be near haploid. Differentiation of these spermatids is similar to the process observed in diploid fowls except that there is a high percentage of abnormally shaped heads. The fact that morphologically normal spermatozoa were rare is consistent with the expectation that very few spermatozoa would be exactly haploid. In both ZZZ and ZZW triploid fowls, triple pairing of chromosomes is observed in synaptonemal complexes (SC) during meiosis and recombination nodules are distributed at random in the central regions of the triple pairing SC. In ZZW triploid fowls gamete formation is more severely affected than in ZZZ triploid fowls and it is suggested that many of the degenerative changes occurring in ZZW fowls could be attributed to those spermatids that possess a W sex chromosome, since normal male fowls are the homogametic sex (ZZ) and normal spermatids and spermatozoa contain only a Z sex chromosome.

For more than a decade transient resonance Raman spectroscopy using pulsed laser excitation has been an established technique[1] for probing the excited states of metal complexes, though there are relatively few reports of true time-resolved resonance Raman (TR3) studies involving two lasers in a pump-delayed probe arrangement. Some recent examples are listed [2,3]. We have used such two laser methods on the nanosecond timescale to investigate the decay processes following metal-ligand charge-transfer (MLCT) excitation of some heteroleptic complexes of Ru(II) with the novel ligand 1,4,5,8,9,12-hexaazatriphenylene (HAT) and either 2,2′-bipyridyl (bpy), 1,4,5,8-tetraazaphenanthrene (TAP) or 1,10-phenanthroline (phen).

An unusual giant-cell granulomatous inflammatory oral lesion is characterised by the presence of hyaline rings and by a lack of agreement on their nature, opinions ranging from their being hyaline degenerative blood-vessels to remains of leguminous cells. Ten such lesions and a variety of vegetables have been examined in the present investigation. Light-microscopical examination of the lesions revealed the hyaline rings surrounded by inflamed granulation tissue with associated multinuclear giant cells. Electron-microscopical examination showed them to consist of a material similar to that of vegetable cell walls, sometimes with an associated superficial layer of collagen. The observations indicate that the lesions consist of vegetable remains with an associated foreign-body type of inflammatory response.

A method for determining the moisture content of wool with a minimum disturbance to the constituents is described. The method was used to show differences in moisture content according to anatomical site, age, sex, strain of merino and in lesions of fleece rot, bacterial stain and active flystrike. The incidence of natural flystrike was recorded and related to the higher levels of moisture content. The moisture content in proximal wool was found to increase at different rates, following wetting of the fleece with droplets of water falling under gravity to simulate rain. A level of 20 per cent moisture content was reached after different time intervals in different strains of merino sheep, which may explain one of the differences in strain susceptibility to fleece rot

The anthelmintic efficacy of low-dose phenothiazine therapy, administered as a 1:40 phenothiazine: molasses mixture, was tested against patent infections of strains of Haemonchus contortus, Trichostrongylus colubriformis and Ostertagia spp susceptible or resistant to thiabendazole (an other benzimidazoles), levamisole and morantel tartrate. Phenothiazine reduced faecal egg output for both susceptible and resistant strains of all three nematodes. In daily doses of 0.25 g per sheep per day and above it completely inhibited larval production in susceptible strains. Against resistant strains, there was a reduced efficiency with 82.3 per cent inhibition of egg hatch at the 0.25 g per sheep per day level. Phenothiazine treatment had no significant effect on worm numbers for either susceptible or resistant worms. It is suggested that benzimidazole-resistant strains may be cross-resistant to phenothiazine.

A drying agent (B26) was applied as a mist to sheep fleece. A reduction of 30 per cent in wool moisture was recorded, which persisted for 10 to 12 weeks. Reapplication of B26 extended the period of dryness, without adding to the reduction of moisture. Treatment using 100 to 200 ml of the drying agent resulted in reduced fleece moisture content for seven days when exposed to wetting by simulated rain. Treated sheep showed a 60 per cent reduction in the number and severity of fleece rot lesions. Diazinon reduced the incidence of natural flystrike by 50 per cent and the drying agent by 75 per cent over a five week period before shearing compared with untreated animals.

Guinea pigs infected with Trichostrongylus colubriformis were used to develop an assay for anthelmintic resistance by determination of worm burdens following treatment with test anthelmintics. To achieve comparable efficacy with the recommended dose of thiabendazole and levamisole in sheep, dose rates in guinea pigs had to be increased two to four fold. For example, thiabendazole at 100 mg/kg in guinea pigs was 96.6 per cent effective against a thiabendazole susceptible (GS) strain of T colubriformis, but had no effect against a thiabendazole-resistant (VRSG) strain. In sheep 50 mg/kg of thiabendazole would have a similar efficacy against each strain respectively. Morantel tartrate at 10 mg/kg in guinea pigs was 99 to 100 per cent effective against the GS strain but only 54 per cent effective against a morantel resistant (PF4) strain. A slope ratio assay was used to calculate the relative potency of anthelmintics by comparing efficacies against resistant strains with efficacy against the GS strain. Resistance of the VRSG strain to thiabendazole was confirmed with a relative potency for this drug of 0.047 in guinea pigs. The PF4 strain was resistant to both thiabendazole and levamisole which had relative potencies of 0.168 and 0.255 respectively. The advantages of this statistical treatment together with the cost and time savings of the guinea pig model over a conventional critical anthelmintic assay in sheep are discussed.

The effects of acepromazine maleate (ACP), given orally in a paste form, were examined in six standard-bred geldings over a 12 hour period. Three dose rates, zero (placebo paste), 0.13 mg kg-1 and 0.26 mg kg-1, given before or after feeding, were investigated. The data were divided into two sampling periods for analysis, one from zero to 120 minutes and the other from four to 12 hours. Sedation was assessed by a score (TS score) based on general appearance, anal sphincter relaxation and penile protrusion. This TS score was significantly elevated 40 minutes after dosing with ACP, irrespective of whether the horses had been fed or not. Dose rate had no significant effect on TS in the zero to 120 minute sampling period, but the TS score was significantly (P less than 0.01) higher at the higher dose rate in the four to 12 hour period. At both dose rates, the TS scores were still significantly higher than their pretreatment values 12 hours after dosing. Systolic blood pressure (SBP), measured indirectly from the coccygeal artery, haematocrit (PCV) and total plasma protein concentration (TPP) were also examined. ACP caused significant falls in SBP and PCV, but the effect was complicated by feeding. ACP given after feeding had a reduced effect on SBP and PCV. Feeding appeared to cause a rise then a fall in PCV and TPP which was superimposed upon the fall caused by ACP. There was no difference between the two dose rates of ACP on SBP and PCV.(ABSTRACT TRUNCATED AT 250 WORDS)

Low-dose daily phenothiazine therapy, administered as a 1:40 phenothiazine:molasses mixture, was tested against sequential infections of strains of Haemonchus contortus. Trichostrongylus colubriformis and Ostertagia spp susceptible or resistant to thiabendazole, levamisole and morantel tartrate. Phenothiazine at a dose rate of 0.5 g per sheep per day significantly reduced the numbers of worm eggs per gram of faeces in both susceptible and resistant strains by an average of 48 per cent and 60 per cent respectively. Phenothiazine completely inhibited larval production in susceptible strains. With resistant worms, larval production was depressed by up to 85.7 per cent. Treatment with phenothiazine : molasses mixture reduced the numbers of worms which became established in resistant Ostertagia spp and susceptible T colubriformis but had no effect on the establishment of susceptible H contortus and Ostertagia spp or resistant H contortus and T colubriformis.

A benzimidazole resistant strain of Haemonchus contortus was passaged through lambs only or from lambs to calves and back into lambs. Changes in response to thiabendazole were monitored by using an egg hatch test at each animal passage and by a controlled experiment on adult worms at the final passage in lambs. An increased level of resistance was shown for the isolate during its passage through calves by the egg hatch test, although this was not supported on the adult worms in sheep using a single dose rate of 66 mg/kg of thiabendazole.

Observations of erratic anthelmintic activity of fenbendazole against known standardised thiabendazole-resistant strains of Haemonchus contortus and Trichostrongylus colubriformis in sheep were investigated. Fenbendazole at a dose rate of 10 mg/kg body weight was administered by oral, intra-ruminal or intra-abomasal routes, and was most effective against both resistant strains following intra-ruminal administration. In addition thiabendazole, oxibendazole, fenbendazole, parbendazole and mebendazole plus two unrelated compounds, levamisole and morantel tartrate, were used at one and a half times their suggested or recommended therapeutic dose rate against thiabendazole-resistant strains of H contortus and T colubriformis in sheep; each drug being administered by the intra-ruminal or intra-abomasal routes. Fenbendazole was more effective against both strains following intra-ruminal administration. Parbendazole was more effective against the resistant strain of T colubriformis following intra-ruminal administration. At the dose rate chosen for the other benzimidazoles used against these resistant strains, there was no difference in anthelmintic efficacy due to route of administration. Levamisole was highly effective against both resistant strains, irrespective of the route of administration. In the groups treated with morantel tartrate, the results obtained were difficult to interpret due to mortalities and a highly variable response in the surviving sheep. Fenbendazole, thiabendazole and mebendazole when used at their suggested or recommended therapeutic dose rate in sheep, were highly effective against known thiabendazole-susceptible strains of H contortus and T colubriformis following both intra-ruminal or intra-abomasal administration.

The influence of egg yolk, glycerol and the freezing rate on the survival of ram spermatozoa and on the structure of their acrosomes after freezing was investigated. Egg yolk was shown to be beneficial not only during chilling but also during freezing; of the levels examined, 1� 5 % gave the greatest protection. Although the presence of glycerol in the diluent improved the survival of spermatozoa, increasing concentrations produced significant deterioration of the acrosomes. With closely controlled linear cooling rates, no overall difference was detected in the survival of spermatozoa frozen at rates between 6 and 24�C per min. However, a significant interaction between freezing rate and the inclusion of glycerol in the diluent showed that glycerol was less important at the highest freezing rate. A sudden cooling phase near to the freezing point following the release of the latent heat of fusion was not detrimental to spermatozoa.