bluuebunny/crossref_metadata_2025 huggingface dataset:
Urinary Bladder Herniation through a Vaginal Tear in a Rottweiller with Dystocia
Authors: Mandell Deborah C. , Neath Prue , Drobatz Kenneth J.
Published: July 2007

A four‐year old female Rottweiler presented with a 34‐hour history of dystocia. Physical examination revealed a purple‐black, fluid‐filled sac protruding from vulva and suspended by a similar colored stalk. Digital vaginal examination indicated that the stalk of tissue extended up into the cervix and beyond. Due to the grossly necrotic appearance, the stalk of tissue was ligated, and the sac was removed. Three puppies were delivered vaginally, but a subsequent caesarian section was required due to uterine inertia likely secondary to exhaustion. Three more live puppies were delivered via the c‐section. Further abdominal exploration revealed a tear in the left vaginal wall, one ligated ureter, and the second ureter free at its distal end and leaking urine into the abdomen. The surgical findings indicated that the bladder, ureters, and urethra had herniated through the vaginal tear and prolapsed through the vulva.
Treatment of a Myasthenic Dog with Mycophenolate Mofetil
Authors: Dewey C.W. , Boothe D.M. , Rinn K.L. , Coates J.R. , Burkholder W.J.
Published: July 2007

A ten‐year‐old, male castrated Springer Spaniel was presented for dysphagia, ptyalism, and regurgitation. Evidence of megaesophagus and mild aspiration pneumonia were apparent on thoracic radiographs. A diagnosis of focal acquired myasthenia gravis was suspected and subsequently confirmed with a positive serum acetylcholine (ACh) receptor antibody concentration (3.87 nM/L). A gastrostomy tube was placed shortly after presentation; food and drugs (including azathioprine) were administered through the tube. After transient improvement, the dog suddenly deteriorated clinically, experiencing frequent episodes of regurgitation and developing severe aspiration pneumonia. Mycophenolate mofetil (MMF), a novel immunosuppressive drug with relative specificity for lymphocytes, was instituted every twelve hours via the gastrostomy tube. Within four days of beginning MMF therapy, both clinical evidence of pharyngeal/esophageal dysfunction and radiographic evidence of megaesophagus had resolved. Initially, clinical side‐effects of combined MMF/AZA administration were not apparent, but the patient experienced several vomiting episodes during the third week of treatment. The vomiting resolved after decreasing the dose of both drugs. The patient made a full recovery, and a one‐month follow‐up ACh receptor antibody concentration was normal (0.26 nM/L). After one month of combination therapy, the patient was weaned off of AZA and maintained on MMF as the sole immunosuppressive drug. The dog was subsequently weaned off of MMF on two occasions. Mycophenolate mofetil was reinstituted after the first discontinuation due to the development of profound appendicular muscle weakness two days after stopping MMF; the weakness resolved within 24 hours of reinstituting MMF. A positive ACh receptor antibody concentration (0.89 nM/L) after the second MMF weaning prompted the second reinstitution of MMF. Two months following this second MMF reinstitution, the dog was again serologically negative (0.51 nM/L) for myasthenia gravis. At the time of last followup, the dog remained in clinical remission eight months after initial presentation. The use of MMF to treat acquired myasthenia gravis in dogs has not been reported previously. The literature concerning MMF and its potential use in treating patients with autoimmune diseases is discussed.
Initial Experience with Norepinephrine Infusion in Hypotensive Critically III Foals
Authors: T. Corley Kevin , C. McKenzie Harold , M. Amoroso Lisa , O. Furr Martin
Published: July 2007

Seven critically ill foals that continued to be hypotensive despite fluid resuscitation and the infusion of dobutamine and/or dopamine were treated with an infusion of norepinephrine (noradrenaline). The norepinephrine was administered concurrently with dobutamine, and the combination therapy was titrated by use of indirect mean arterial pressure measurements. The highest dose of norepinephrine used was 1.5 mcg/kg/min. In six foals the administration of norepinephrine was associated with an increase in blood pressure. In one foal the mean arterial pressure did not increase in response to the doses of norepinephrine administered. All of the foals experienced an increase in urine output coincident with the start of the norepinephrine infusion. Three of the foal survived to hospital discharge.
Management of Acetaminophen and Ibuprofen Toxicoses in Dogs and Cats
Authors: Richardson Jill A.
Published: July 2007

Acetaminophen and ibuprofen are commonly used in humans for their analgesic, anti‐pyretic, and anti‐inflammatory (ibuprofen) effects. Between January 1998 and March 2000, veterinarians at the ASPCA Animal Poison Control Center (APCC) consulted on more than 1,050 cases of accidental exposures to acetaminophen and 1,100 cases of ibuprofen ingestion in dogs and cats. Exposures to these medications can have serious effects on the animal's health. Fortunately, with prompt, aggressive treatment and good supportive care, most animals will recover completely.
The Treatment of Acute Adrenocortical Insufficiency in the Dog
Authors: Schaer Michael
Published: July 2007

Acute hypoadrenocorticism in the dog is a true medical emergency that requires a prompt and accurate diagnosis and appropriate treatment in order to provide for the most optimal outcome. Because the signs of adrenal insufficiency mimic those caused by other more common clinical conditions such as renal failure, intoxications, and various gastrointestinal disorders, it behooves the emergency clinician to always include this condition in the list of differential diagnoses. This paper will review the main elements of this hypoendocrinopathy in order to provide the emergency clinician with the essentials that will be required for appropriate diagnosis and treatment.

J Vet emerg Crit Care 2001; 11(1):7–14
Mechanical Ventilation of a Dog with Pentobarbital Intoxication
Authors: de Laforcade Armelle M. , Rozanski Elizabeth , Good Lillian , Rush John E.
Published: July 2007

A 9‐year old spayed female American bulldog presented 5 hours after ingesting a portion of a recently euthanized sheep carcass. The dog was comatose, intubated and manually ventilated on arrival. On physical examination, the dog had stable cardiovascular parameters but was hypothermic. Cranial nerve reflexes were absent and spinal reflexes were depressed. Mechanical ventilation was initiated and maintained for 18 hours before spontaneous respiration returned. Elevated serum pentobarbital concentration (19.1 mg/ml) confirmed pentobarbital intoxication as the cause of neurological signs. This is the first report of a dog with pentobarbital toxicity that was successfully managed with mechanical ventilation. Neurologic and functional recovery was complete and the dog was discharged 48 hours after admission. (J Vet Emerg Crit Care 2001; 11(1):33–37)
Colloid Osmotic Pressure of Parenteral Nutrition Components and Intravenous Fluids
Authors: Chan Daniel L. , Freeman Lisa M. , Rozanski Elizabeth A. , Rush John E.
Published: July 2007

Objective:Parenteral nutrition is an important part of therapy for critically ill animals that cannot tolerate enteral feedings. It has been hypothesized that parenteral nutrition might also play a role in increasing colloid osmotic pressure (COP). The purpose of this study was to measure COP of various parenteral nutrition components and compare them to the COP of commonly used intravenous solutions.

Design:Membrane colloid osmometry was used to measure the COP of parenteral nutrition components (lipids, Abstractamino acids, dextrose solutions) and of synthetic colloids, crystalloids, and blood products.

Main Results:Parenteral nutrition components and all crystalloid solutions had COP measurements < 1 mm Hg. Great variation in COP was found in the different artificial colloids and blood products. The COP of the artificial colloids tested ranged from 32.7 ± 0.2 mm Hg for hetastarch to 61.7 ± 0.5 mm Hg for dextran 70.

Conclusions:The results of this in vitro study suggest that parenteral nutrition does not directly contribute to an increase in oncotic pressure. Further studies are needed to determine whether parenteral nutrition may indirectly influence COP in vivo. Knowing the COP of a fluid, along with its other properties, is useful in making appropriate therapeutic decisions.
Accidental 5‐Fluorouracil Exposure in a Dog
Authors: Roberts Jennifer , Powell Lisa L.
Published: July 2007

objective:
To demonstrate the range of toxicities with 5‐Fluorouracil (5‐FU).

Case Summary:
A one‐year‐old male castrated Labrador Retriever presented to the University of Minnesota Veterinary Teaching Hospital Emergency Service following accidental ingestion of a 5% 5‐Fluorouracil (5‐FU) topical antineoplastic cream. The animal presented with status epilepticus and later demonstrated additional clinical signs consistent with 5‐FU toxicosis including mucositis and diarrhea, profound but transient leukopenia, and thrombocytopenia.

New Information Provided:
The calculated ingested dosage was 46 mg/kg. The dog responded well to intensive therapy, recovering uneventfully.
Epidural Catheter Analgesia in Dogs and Cats: Technique and Review of 182 Cases (1991–1999)
Authors: Hansen Bernie D.
Published: July 2007

Objective:To characterize the indications and techniques for catheterization of the epidural space to treat pain in dogs and cats in a veterinary teaching hospital intensive care unit, and describe the analgesic regimens used in those patients. To provide a detailed description of the technique of epidural catheterization in companion animals.

Design:Retrospective case series and clinical practice review.

Setting:The Veterinary Teaching Hospital at the North Carolina State University College of Veterinary Medicine.

Animals:Records from 160 dogs and 22 cats that had epidural catheters placed were identified.

Interventions:Epidural catheterization for the purpose of providing analgesia for a variety of surgical and medical disorders was performed on both awake and anesthetized patients.

Measurements and main results:The most frequently used analgesic agents were preservative‐free morphine and bupivacaine. 2The range of duration of catheter dwell time was 1.3–332 hours, with a mean duration of 50 hours and a median of 39 hours. Suspicion of catheter malpositioning prompted radiographic imaging of the catheter in 44 patients, and malpositioning was confirmed in 6 of those. Catheter tip positioning was recorded in 46 patients. The tip was located at L3‐L6 in 16, and T5‐L3 in 30. Twenty‐seven of those 30 patients were catheterized to treat pain associated with thoracotomy, forelimb amputation, pancreatitis, or peritonitis. Fifty‐one (28%) patients received no analgesics beyond those provided by the epidural catheter.

Conclusions:Epidural administration of analgesia appeared to provide significant pain relief and was adequate as a sole analgesic treatment in some patients. Serious complications in these critically ill animals appeared to be uncommon. (J Vet Emerg Crit Care 2001; 11(2): 95–103)
Thrombolytic Therapy in Dogs and Cats
Authors: Thompson Mary F. , Scott‐Moncrieff J. Catharine , Hogan Daniel F.
Published: July 2007

Objective:To review the thrombolytic agents most commonly used in humans, their mechanisms of action, potential uses, adverse effects, and reports of their use in dogs and cats.

Human data synthesis:Thrombolytic agents avaliable in human medicine include streptokinase, urokinase, tissueplasminogen activator (t‐PA), single‐chain urokinase plasma activator (scu‐PA) and anisoylated plasminogen‐strep‐tokinase activator complex (APSAC). These agents were originally used for the management of proximal deep vein thrombosis and severe pulmonary embolism but more recently, use of these drugs has been extended to include the treatment of acute peripheral arterial disease, cerebrovascular disease (stroke) and acute coronary thrombosis. The most predictable side effect associated with the use of thrombolytic therapy is hemorrhage.

Veterinary data synthesis:Clinical experience with thrombolytic agents in small animals is limited to streptokinase and t‐PA. It is possible, that as in humans, canine and feline patients with PTE and right ventricular dysfunction may benefit from thrombolytic therapy but there are no veterinary studies to support this theory to date. Successful use of streptokinase has been documented in a small number of canine patients with systemic thromboembolism.63Thrombolytic therapy is relatively efficacious in cats with aortic thromboemboli but is associated with a high mortality rate.59,60,64With regard to use of t‐PA in veterinary medicine, the small number of animals treated with varying protocols makes it impossible to provide safe and effective dose recommendations at this time.

Conclusions:Future goals for thrombolytic therapy in veterinary medicine include determination of more specific clinical indications, as well as design of effective protocols that minimize mortality and morbidity.
Pyothorax in Neonatal Boxer
Authors: Schoeffler Gretchen L. , Rozanski Elizabeth A. , Rush John E.
Published: July 2007

Objective:To report a case of pyothorax in a critically ill canine neonat.

Case Summary:A12‐day old, female boxer puppy was presented for lethargy, fever and respiratory distress. Pleural ceffusion was apparent on thoracic radiography. Thoracentesis and subsequent cytology and bacteriologic culture of the Pleural effusion, confirmed a diagnosis of pyothorax. Clinical management of pyothorax in critically ill 12‐day‐ old puppy is decribed

New or Unique information provided:Pyothorax can occur in the caine neonate.J Vet Emerg crit care2001;11(2): 147–152)
Esophagostomy Tubes: Don't Underutilize Them!
Authors: Mazzaferro Elisa M.
Published: July 2007

Critical care veterinarians observe a wide variety of patients who easily become malnourished and display negative nitrogen balance due to inappetance, complete anorexia, vomiting, or inability to normally prehend food, as in patients with head and facial trauma (Tables 1 and 2). Negative nitrogen balance is associated with delayed wound healing and increased incidences of gastroinstestinal mucosal atrophy, bacterial translocation, sepsis, and mortality. Early interventional nutrition is necessary for maintenance of normal function and for proper healing to occur. While total parenteral nutrition (TNP) is an option, enteral nutrition is preferred whenever possible. Enterocytes undergo atrophy within several days in the absence of direct trophic stimuli Within the intestinal lumen.

“If the gut works, use it” has gained widespread Popularity in early interventional nutrition in the critically ill veterinary patient. Force‐Feeding is often stressful for both patient and caretaker alike. Instead, tube feeding is often well tolerated and an easier route for enteral nutrition. The following methods of tube feeding have been described: nasoesophageal, nasogastic, nasojejunostomy, esophagostomy, pharyngostomy, gastrostomy, and jejunostomy.

Esophagostomy tubes were first described for use in human patients with maxillofacial and cervical neoplasta. Later, Dr. Crowe described their use for veterinary patients (1989). Since that time, several methods for esophagostomy tube placement have been proposed. The modified percutaneous method is one of the easiest to perform, and requires minimal equipement.
Traumatic Mesenteric Avulsion and Subsequent Septic Peritonitis in a Dog
Authors: Rollings Christopher , Rozanski Elizabeth A. , DeLaforcade Armelle , Kowaleski Michael , Rush John E.
Published: July 2007

Objective:Description of a case of traumatic mesenteric avulsion in a dog resulting in septic peritonitis.

Case Summary:A young dog was presented after having been hit by a car. On initial evaluation, intra‐abdominal injury was not apparent. The dog was discharged and re‐presented with septic peritonitis due to devitalized bowel from mesenteric avulsion. Surgical intervention and supportive care resulted in a successful outcome.

New or Unique Information Provided:Successful management of a rare injury including exploratory celiotomy with intestinal resection and anastomosis, supportive care, and closed suction abdominal drainage. (J Vet Emerg Crit Care 2001; 11(3): 211–215)
Pheochromocytoma Presenting as Acute Retroperitoneal Hemorrhage in a Dog
Authors: Williams Jarod E. , Hackner Susan G.
Published: July 2007

Objective:This report describes the perioperative management of a dog with a right adrenal pheochromocytoma that presented with acute retroperitoneal hemorrhage, cardiac arrhythmia and hypertension. Additionally, a summary of pheochromocytoma and the idiosyncrasies of perioperative management of a pheochromocytoma are provided.

Summary:A 7‐year old male, neutered, Dalmation was presented for acute collapse, abdominal pain and tachycardia. Physical examination findings were consistent with hypoperfusion concurrent with multiple cardiac arrhythmias and hypertension. Abdominal ultrasound revealed retroperitoneal effusion and a right adrenal mass intimately associated with the caudal vena cava. Incomplete right adrenalectomy was performed. Histopathology confirmed a pheochromocytoma.

Unique information provided:To the authors' knowledge, this is the first definitive report of acute retroperitoneal hemorrhage as the initial clinical manifestation of histologically confirmed adrenal pheochromocytoma in the dog. (J. Vet Emerg Crit Care 2001; 11(3): 221–227)
Metabolic Syndrome Is Associated With Coronary Artery Calcium in Asymptomatic White Brazilian Men Considered Low‐Risk by Framingham Risk Score
Authors: Santos Raul D. , Nasir Khurram , Tufail Kashif , Meneghelo Romeu Sergio , Carvalho Jose A. M. , Blumenthal Roger S.
Published: July 2007

The authors investigated whether the metabolic syndrome is associated with coronary artery calcium (CAC) independently of 10‐year coronary heart disease risk assessment by Framingham risk scores (FRS) in asymptomatic white Brazilian men. In a group of 458 men (mean age 46±7 years), the 10‐year coronary heart disease risk was 9%±8%, and the metabolic syndrome and CAC were present in 24% and 41% of the participants, respectively. Compared with those classified as low risk (<10% FRS; n=256), men with FRS of 10% or more had an odds ratio of 4.57 (95% confidence interval, 3.08–6.82; P<.0001) for the presence of any CAC. The prevalence of CAC increased monotonically with the increasing number of metabolic syndrome components (none=29%, 1 or 2=44%, and ≥3=51%, P=.002 for trend). The presence of the metabolic syndrome was associated with an increased risk of CAC: odds ratio, 1.94 (95% CI, 1.05–3.61); however, this finding was significant only in those individuals classified as low risk (FRS <10%). In conclusion, metabolic syndrome is associated with subclinical atherosclerosis in Brazilian participants considered at low risk according to FRS.
Hypertension After Renal Transplant
Authors: Tedla Fasika , Hayashi Rick , McFarlane Samy I. , Salifu Moro O.
Published: July 2007

Hypertension is common after renal transplant and is associated with adverse graft and patient outcomes. A thorough understanding of the unique factors that operate in renal transplant recipients is essential for the proper evaluation and management of this disorder. In this review, the authors outline the pathogenesis, diagnostic workup, and treatment of hypertension after renal transplant.
Cardiovascular Function in Normotensive Offspring of Persons With Essential Hypertension and Black Race
Authors: Mohler Emile R. , O'Hare Kitty , Darze Eduardo S. , Townsend Raymond R. , Bridges Charles R. , Keane Martin G.
Published: July 2007

Prior investigations have shown impaired endothelial function in hypertensive blacks when compared with whites. It is not clear, however, whether the difference in vascular responsiveness predates or follows the development of hypertension. Thirty‐nine young black adults with a family history of essential hypertension and 41 control participants were studied for brachial artery reactivity and carotid intima‐media thickness via ultrasonography, cardiac muscle mass and diastolic function by echocardiography, and biochemical analysis. There was no significant difference in brachial artery reactivity between the study groups, although women had greater reactivity than men (P=.05). Carotid intima‐media thickness, left ventricular geometry, and biomarkers were equivalent between the study groups (P=not significant). Vascular imaging and biomarkers were unable to identify early evidence of endothelial dysfunction in offspring of African Americans with essential hypertension. These same studies demonstrated some early changes in vascular function based on sex.
The Status of Intravenous Valproate for Status
Authors: Hirsch Lawrence J.
Published: July 2007

Sodium Valproate vs Phenytoin in Status Epilepticus: A Pilot Study. Misra UK, Kalita J, Patel R. Neurology 2006;67(2):340–342. Sixty-eight patients with convulsive status epilepticus (SE) were randomly assigned to two groups to study the efficacy of sodium valproate (VPA) and phenytoin (PHT). Seizures were aborted in 66% in the VPA group and 42% in the PHT group. As a second choice in refractory patients, VPA was effective in 79% and PHT was effective in 25%. The side effects in the two groups did not differ. Sodium valproate may be preferred in convulsive SE because of its higher efficacy.
The Best Model for a Cat is the Same Cat … or is It?
Authors: Mazarati Andrey
Published: July 2007

Effect of Antiepileptic Drugs on Spontaneous Seizures in Epileptic Rats. Nissinen J, Pitkänen A. Epilepsy Res 2007;73:181–191. The present study investigated whether spontaneously seizing animals are a valid model for evaluating antiepileptic compounds in the treatment of human epilepsy. We examined whether clinically effective antiepileptic drugs (AEDs), including carbamazepine (CBZ), valproic acid (VPA), ethosuximide (ESM), lamotrigine (LTG), or vigabatrin (VGB) suppress spontaneous seizures in a rat model of human temporal lobe epilepsy, in which epilepsy is triggered by status epilepticus induced by electrical stimulation of the amygdala. Eight adult male rats with newly diagnosed epilepsy and focal onset seizures were included in the study. Baseline seizure frequency was determined by continuous video-electroencephalography (EEG) monitoring during a 7 days baseline period. This was followed by a 2–3 days titration period, a 5–7 days treatment period, and a 2–3 days wash-out period. During the 5–7 days treatment period, animals were treated successively with CBZ (120mg/kg/day), VPA (600mg/kg/day), ESM (400mg/kg/day), LTG (20mg/kg/day), and VGB (250mg/kg/day). VPA, LTG, and VGB were the most efficient of the compounds investigated, decreasing the mean seizure frequency by 83, 84, and 60%, respectively. In the VPA group, the percentage of rats with a greater than 50% decrease in seizure frequency was 100%, in the LTG group 88%, in the VGB group 83%, in the CBZ group 29%, and in the ESM group 38%. During the 7 day treatment period, 20% of the VPA-treated animals and 14% of the CBZ-treated animals became seizure-free. These findings indicate that rats with focal onset spontaneous seizures respond to the same AEDs as patients with focal onset seizures. Like in humans, the response to AEDs can vary substantially between animals. These observations support the idea that spontaneously seizing animals are a useful tool for testing novel compounds for the treatment of human epilepsy.
Is Too Much Inhibition to Blame in Autosomal Dominant Nocturnal Frontal Lobe Epilepsy?
Authors: Mathews Gregory C.
Published: July 2007

Seizures and Enhanced Cortical GABAergic Inhibition in Two Mouse Models of Human Autosomal Dominant Nocturnal Frontal Lobe Epilepsy. Klaassen A, Glykys J, Maguire J, Labarca C, Mody I, Boulter J. Proc Natl Acad Sci USA 2006;103(50):19152–19157. Selected mutations in the human α4 or β2 neuronal nicotinic acetylcholine receptor subunit genes cosegregate with a partial epilepsy syndrome known as autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE). To examine possible mechanisms underlying this inherited epilepsy, we engineered two ADNFLE mutations ( Chrna4S252F and Chrna4+L264) in mice. Heterozygous ADNFLE mutant mice show persistent, abnormal cortical electroencephalograms with prominent delta and theta frequencies, exhibit frequent spontaneous seizures, and show an increased sensitivity to the proconvulsant action of nicotine. Relative to WT, electrophysiological recordings from ADNFLE mouse layer II/III cortical pyramidal cells reveal a >20-fold increase in nicotine-evoked inhibitory postsynaptic currents with no effect on excitatory postsynaptic currents. i.p. injection of a subthreshold dose of picrotoxin, a use-dependent γ-aminobutyric acid receptor antagonist, reduces cortical electroencephalogram delta power and transiently inhibits spontaneous seizure activity in ADNFLE mutant mice. Our studies suggest that the mechanism underlying ADNFLE seizures may involve inhibitory synchronization of cortical networks via activation of mutant α4-containing nicotinic acetylcholine receptors located on the presynaptic terminals and somatodendritic compartments of cortical GABAergic interneurons.
Glycoprotein IIb/IIIa Antagonists in the Setting of Rescue Percutaneous Coronary Intervention
Authors: ARORA UMESH K. , CONDE IAN , KLEIMAN NEAL S.
Published: July 2007

It is clear that survival and better outcomes after acute myocardial infarction (AMI) are dependent on rapid, complete, and sustained reperfusion of the affected myocardium. Thrombolytic therapy is currently the most common reperfusion strategy in AMI, however, a significant proportion of patients fail to reach reperfusion with this form of therapy. There is evidence from randomized trials that rescue percutaneous coronary intervention (PCI) for failed thrombolysis may convey better outcomes to patients when compared to a conservative management. Nevertheless, it is not surprising that in this inherently thrombogenic milieu, rescue PCI has a lower success rate and a high incidence of rethrombosis, which have a profoundly negative impact on the outcome of patients. Platelets are thought to play a central role in the pathophysiology of failed thrombolysis and in the thrombotic complications following PCIs. Therefore, platelet glycoprotein (GP) IIb/IIIa antagonist may be of benefit in the setting of rescue PCI. Two retrospective subgroup analyses have suggested that these potent antiplatelet agents may improve the outcome of patients undergoing rescue PCI after failed full‐dose thrombolytic therapy. An increase in major bleeding, however, has also been noted. Therefore, in light of the lack of evidence deriving from randomized, placebo‐controlled trials, careful consideration of several aspects relevant to this setting is needed before GP IIb/IIIa antagonists are administered in rescue percutaneous coronary procedures.
Clopidogrel as an Antiplatelet Agent in Transplant Heart Coronary Stenting
Authors: MAHADEVAN VAIKOM S. , KHAN MAZHAR M. , ADGEY JENNIFER A.A.
Published: July 2007

Clopidogrel is increasingly used as an antiplatelet agent along with aspirin in coronary stenting due to its safety profile and clinical efficacy. This report describes a case of successful direct coronary stenting in a transplanted heart with the use of clopidogrel and aspirin therapy. Vessel patency was preserved with no evidence of in stent restenosis on 4‐month follow‐up angiography.
Successful Concomitant Treatment of a Coronary‐to‐Pulmonary Artery Fistula and a Left Anterior Descending Artery Stenosis Using a Single Covered Stent Graft: A Case Report and Literature Review
Authors: BALANESCU SERBAN , SANGIORGI GIUSEPPE , MEDDA MASSIMO , CHEN YUNDAI , CASTELVECCHIO SERENELLA , LUIGIINGLESE M.D
Published: July 2007

This report describes a case of a 47‐year‐old man who presented with early post‐Q wave myocardial infarction angina and an atherosclerotic left anterior descending stenosis associated to a coronary‐to‐pulmonary artery fistula. Both coronary stenosis and fistula were successfully treated with a single polytetrafluoroethylene‐covered stent graft implantation by intravascular ultrasound‐guided procedure.
Exercise‐Induced Nonsustained Ventricular Tachycardia: A Significant Marker of Coronary Artery Disease?
Authors: FEJKA MARTIN , CORPUS ROBERTO A. , ARENDS JOSEPH , O'NEILL WILLIAM W. , FRANKLIN BARRY A.
Published: July 2007

Diagnostic exercise stress testing is commonly performed in patients with known or suspected cardiovascular disease. The significance of an ischemic response, manifested as significant ST‐segment depression, angina pectoris, transient myocardial perfusion abnormalities, or combinations thereof, is well established. However, the diagnostic implications of exercise‐induced nonsustained VT are uncertain, especially as an isolated finding. The patient had threatening ventricular arrhythmias at peak exercise without an ischemic response. Subsequent cardiac catheterization revealed significant CAD requiring percutaneous coronary intervention.
Clinical and Angiographic Results with the Coroflex Coronary Stent System
Authors: KALMBACH CLAUDIA , RUTSCH WOLFGANG , FIGULLA HANS‐REINER
Published: July 2007

This is the first prospective study investigating the safety and efficacy of the new Coroflex Coronary Stent System regarding the incidence of major adverse cardiac events and the angiographic results during 6‐month follow‐up. The balloon‐expandable Coroflex Stent is composed of stainless steel 316L, designed as a “slotted tube” with a 0.04” (0.97mm) low crossing profile and high flexibility. A metal coverage of 12% allows easy side branch access. Between September 1998 and December 1998 five centers enrolled 113 patients with stable or unstable angina and a single de novo lesion in vessel sizes ≥ 2.75 mm. Procedural success was achieved in all 113 (100%) patients. During hospital stay one (0.88%) patient sustained a non‐Q‐wave myocardial infarction. Three patients died of a noncardiac reason during the 6‐month follow‐up. Quantitative coronary angiography (QCA) showed a minimal luminal diameter prior to intervention of 0.78 ± 0.32 mm after PTCA 2.77 ± 0.43 mm, and after 6 months a decrease to 2.06 ± 0.76 mm, resulting in a loss index of 0.29 ± 0.52 and a restenosis rate of 15.6% by QCA (n = 64) and 12.0% by visual estimation of additional 19 patients not suitable for QCA. The results of the Coroflex study demonstrated a low incidence of clinical events and complications and was combined with a low loss index and restenosis rate.
Occlusion of an Aberrant Artery to a Pulmonary Sequestration Using a Duct Occluder
Authors: CRUSHELL ELLEN , SAIDI ARWA , AL‐HASSAN ALI , WALSH KEVIN
Published: July 2007

This report describes a female infant with a rare chromosome defect, del. 12 (q22‐24.1), who has severe pulmonary valve stenosis, an atrial septal defect, and a small muscular ventricular septal defect. At 4 months of age a balloon pulmonary valvuloplasty was performed in the cardiac catheterization laboratory. During the procedure, a large aberrant artery from the aorta to a sequestration of the right lower lobe of lung was found. The flow‐off from the sequestration was into a dilated left atrium. The single artery supplying the sequestration was successfully occluded using an Amplatzer Duct Occluder device. There were no complications and the infant remains well at 1‐yearfollow‐up.
Uneventful 25‐Year Course of an Intracardiac Intravenous Catheter Fragment in the Right Heart
Authors: AKKER‐BERMAN LILY M. VAN DEN , PINZUR SERGEY , AYDINALP ALP , BREZINS MARC , GELLERMAN MARC , ELAMI AMIR , ROGUIN NATHAN
Published: July 2007

We describe a patient with an intracardiac intravenous catheter fragment in the right heart that was found during fluoroscopy. The catheter fragment had broken off from an intravenous catheter inserted 25 years previously when the patient was admitted after a road accident. There were no complications during these years. The fragment was removed during coronary bypass surgery. Other cases of intracardiac foreign bodies have been described, some causing complications even after many years. Uninfected, these can be removed easily with local interventional techniques. Removal of an infected foreign body per cardiotomy has a much higher mortality risk.
Coronary Artery “Pseudothrombus” Due to Collateral Flow Artifact Distal to Left Circumflex Coronary Stenosis
Authors: MOUHAYAR ELIE N. , BLANKENSHIP JAMES C. , FENSTER BRADLEY D. , ILIADIS ELIAS A. , MCCONNELL TIMOTHY R.
Published: July 2007

Since the complexity, morbidity, and costs of coronary interventions are increased when coronary thrombus is present, identification of the cause of an angiographic filling defect is potentially important. We present a case report and review our experience with a flow artifact that mimicked thrombus (“pseudothrombus”) in the setting of a severe proximal stenosis in the left circumflex coronary artery.
Managing Conflict in Divided Societies: Lessons from Tajikistan
Authors: Slim Randa M. , Saunders Harold H.
Published: July 2007

This article presents a new approach to managing conflict in divided societies and describes how it is being implemented in Tajikistan. This approach involves two interrelated strategies: (1) a five‐stage unofficial dialogue process aimed at probing the dynamics of the conflictual relationships among the parties and designing a sequence of interactive steps to changing the relationships; and (2) a civil society strategy aimed at building institutions of civil society that transcend the traditional divisions in the society.
The Tension Between Empathy and Assertiveness
Authors: Mnookin Robert H. , Peppet Scott R. , Tulumello Andrew S.
Published: July 2007

This article explores two central dimensions of negotiation behavior: empathy and assertiveness. Empathy refers to the process by which negotiators demonstrate an understanding of their counterpart. Assertiveness refers to the process by which a negotiator articulates and advocates her interests. Although many people experience empathy to be incompatible with assertion and vice‐versa, the authors suggest that the most effective negotiators develop expertise along both dimensions.
Vital and Nonvital Bleaching Techniques for Discolored Dentitions
Authors: Jordan Ronald E. , Suzuki Makoto
Published: July 2007

The conservative approach to treatment of discolored dentition using vital and nonvital bleaching is discussed with emphasis on its indications and the specific techniques used.
Porcelain Veneer Restorations for Tetracycline Discoloration
Authors: Jordan Ronald E. , Suzuki Makoto
Published: July 2007

Presentation of a typical case of severe tetracycline discoloration of dentition. Various options and the step‐by‐step method for porcelain veneer restoration are discussed.
The Porcelain Inlay Technique for Posterior Restorations
Authors: Jordan Ronald E. , Suzuki Makoto
Published: July 2007

A method of restoring a stable posterior occlusion using the porcelain inlay technique is discussed.
In Vitro Evaluation of Fluoride and Non‐Fluoride Releasing Orthodontic Adhesives on Bracket Bond Strength
Authors: Rezich Paul M. , Panneton Mark J. , Barkmeier Wayne W.
Published: July 2007

A laboratory study was conducted to evaluate the shear bond strength of a metal orthodontic bracket bonded to enamel with four commercially available orthodontic adhesives. The mean shear bond strengths ranged from 0.95 to 16.59 MPa. A fluoride‐releasing glass ionomer adhesive resulted in significantly lower bond strengths when compared to resin adhesive systems.
The Invisible Class IV Restoration
Authors: Fabl Newton , Swift Edward J.
Published: July 2007

Advances in bonding technology have allowed the dentist to create truly esthetic restorations. However, some clinical situations still present difficult esthetic challenges. A common area of difficulty is the maxillary Class IV, where the interface between restorative material and tooth structure is frequently visible. Using a combination of composite resins, the authors present a technique for solving this problem to create esthetic, natural‐looking Class IV restorations.
Reverse Maryland Bridges: Clinical Applications
Authors: Miller Thomas E.
Published: July 2007

The “Maryland Bridge” or the etched metal‐composite bonded retainer has experienced a variety of clinical applications since its inception as the etched enamel plastic‐bonded Rochette periodontal splint. Through the evolutionary stages of different metals and framework preparation for composite bonding by electrolytic, chemical, and air‐abrasive procedures and the improvements in bonding composites, the bridge has been in clinical use for approximately 9 to 10 years.

Certain clinical and radiographic criteria must be satisfied prior to using the conventional Maryland bridge, but with the unique application of the basic bridge design modified and placed from the labial or buccal position some previously contraindicated uses of the bridge can be reversed by using a unique, if not provocative, application of the bridge design principles.

This article presents two clinical case reports utilizing the Maryland bridge applied from the labial and buccal aspect. Both fixed partial dentures presented have been in place clinically for over 18 months, whereas others of this type have been successfully in place for over 6 years.
In Vitro Evaluation of Two New Dentin Adhesive Systems
Authors: Barkmeier Wayne W. , Huang Chin‐Teh , Hammesfahr Paul D. , Jefferies Steven R.
Published: July 2007

Two new experimental dentin adhesive systems were evaluated to determine in vitro dentin bond strengths and marginal microleakage. Scanning electron microscopy examinations were also conducted on one of the systems that was designed to modify the smear layer. Mean shear bond strength for the two experimental systems were 6.77 ± 1.94 MPa and 18.73 ± 2.4 MPa. Marginal microleakage from the enamel margin was not observed and the experimental primer system limited leakage from the dentin margins. The SEM examinations showed that the primer did not significantly alter the smear layer on the prepared dentin surface.
Magnification in Dentistry
Authors: Caplan Stuart A.
Published: July 2007

The use of today's highly sophisticated dental materials has required a corresponding increase in the technical skills of the operator. Surgical telescopes with high resolution and contrast are replacing plastic lenses of somewhat lesser quality. Moreover, depending on their frame mounting, these ground glass magnifiers are also offering the operator additional comfort and safety. The problem for the dentist, however, is to assess properly the products currently being presented by manufacturers. A detailed description of each device offered by four major suppliers is given relative to true field width and depth, working distance or range, “down time” during prescription changes, usefulness with correction, operator positioning, light admittance, degrees of magnification available, and expense. Photographs of the operator practicing without magnification and then using each of three devices is shown and analyzed. With some exceptions, those instruments providing the most flexibility as regards the above factors are most worthy of the dentist's consideration.
Third Generation Dentin Bonding Agents: A Microleakage Study
Authors: Scherer Warren , Kaim James M. , Weiner Eric , Weiner Sandra , Caruso Joseph
Published: July 2007

This article examines and compares the extent of microleakage after 24 hours in freshly extracted teeth using three newer or “third generation” dentin bonding agents. Gluma/Pekalux and Scotchbond 2/Silux were more effective in preventing microleakage in cementum/dentin margins than was Universal Bond/Prisma Micro‐fine.
Porcelain Veneer Protection Plan: Maintenance Procedures for All Porcelain Restorations
Authors: Miller Lynn At.
Published: July 2007

This article gives the most up to date techniques for successful maintenance of all porcelain restorations. It includes how to prevent the possible accelerated staining due to the porosity of the resin cement. The dentist can remove the glaze of the porcelain by contouring veneers, inlays, or onlays. Also included is what the hygienist or dentist can do to minimize additional damage. Dicor differs from porcelain because it is colored extrinsically and coarse polishing pastes or air‐abrasive polishers can remove the color. This article reviews in detail the necessary procedures for maximum gingival health and the routine scaling and polishing of porcelain restorations. Proper care of porcelain maximizes the esthetic and functioning life of the restoration.
Simultaneous Placement of Multiple Porcelain Veneers
Authors: Putter Harvey , Ibsen Robert L.
Published: July 2007

Although laminate veneers are usually placed individually in order to avoid bonding the anterior teeth together, an alternate technique is presented. The technique described is efficient and time‐saving.
Use of a Visible Light Cured Elastomeric Resin To Stabilize Cervical Matrix in Restoration of Class V Erosion Lesion
Authors: Jefferies Steven R.
Published: July 2007

Effective moisture control and gingival retraction are essential prerequisites for success in the restoration of Class V bonded restorations. Various techniques exist for cervical isolation and moisture control in Class V restorations. This case report details a modified technique in which a visible light cured elastomeric resin was utilized to stabilize a cervical matrix in restoration of a Class V erosion lesion. The resultant customized matrix provides effective isolation, moisture control, and gingival retraction when used in conjunction with Class V restorations.
Rapid Extrusion With Fiberotomy
Authors: Schwimer Charles W. , Rosenberg Edwin S. , Schwimer David H.
Published: July 2007

Rapid extrusion with fiberotomy as an alternative to traditional crown lengthening modalities is described. Given appropriate anatomic conditions, rapid extrusion with fiberotomy may be utilized as a viable and esthetic crown lengthening procedure.
One‐Year Evaluation of a Dentin‐Enamel Bonding System
Authors: Kanca John
Published: July 2007

The 1‐year recall evaluation of a dentin‐enamel bonding system developed by the author is presented. The system has excellent in vitro resistance to dye penetration and can provide gap‐free restorations in vivo. It has shown significant potential for bonding to dentin and enamel.
Fluoride Release From Light‐Cure Liners/Bases: An Eight‐Month Report
Authors: Cooky Robert L. , McCourt James W.
Published: July 2007

Five new visible light‐cure cavity liners/bases that contain fluoride were evaluated for fluoride release over an 8‐month period. Fluoride was released from all the materials but decreased significantly over the test period. There was also a significant difference in the amount of fluoride released between the materials. At 8 months, only XR Ionomer and Vitrabond were releasing detectable fluoride, with XR Ionomer releasing significantly more.
Light‐Cured Resin Cements for Cementation of Esthetic Restorations
Authors: O'Keefe Kathy , Powers John M.
Published: July 2007

Properties and clinical indications of light‐cured resin cements used for cementation of porcelain veneers, all‐porcelain crowns, and tooth‐colored inlays and onlays are reported.
Bond Strength, Microleakage, and Scanning Electron Microscopy Examination of the Prisma Universal Bond 2 Adhesive System
Authors: Barkmeier Wayne W. , Huang Chin‐Teh , Hammesfahr Paul D. , Jefferies Steven R.
Published: July 2007

Dentin shear bond strength and marginal microleakage of a new primer/adhesive system were evaluated in this study and compared to Tenure Solution, Gluma, XR Primer/XR Bond, and Scotchbond 2. In addition, scanning electron microscopy examinations were conducted to evaluate the effect of the new primer on the smear layer, determine the film thickness of the primer/adhesive, and examine the resin‐dentin interface of restorations placed with the new system.
Total Etch—The Rational Dentin Bonding Protocol
Authors: Bertolotti Raymond L.
Published: July 2007

Phosphoric acid etching of dentin is critically reexamined in view of current adhesive resin development. Research and clinical experience both suggest that “total etch,” the simultaneous etching of dentin and enamel, is a rational protocol with many modern adhesive resins.
Evaluation of a 4‐META Porcelain Repair System
Authors: Cooley Robert L. , Tseng Eugene Y. , Evans James G.
Published: July 2007

A recently introduced porcelain repair system utilizing 4‐META (Etch‐Free Primer with C & B‐Metabond) was evaluated for bond strength to porcelain. This system purportedly eliminates hydrofluoric acid‐etching and silane pretreatment. Forty porcelain specimens were prepared and treated with the 4‐META repair system. A resin cylinder was bonded to the treated porcelain surface. Twenty of the specimens were tested after 24 hours while the other 20 were tested after thermocy‐cling (800 cycles at 6° C to 60° C). The mean bond strengths were: 24 hours 17.4 MPa (±4.8), thermocycled 19.1 MPa (±7). Cohesive failure of the porcelain occurred in all of the specimens, both the 24 hour and the thermocycled. These bond strengths compare favorably with or exceed those of other porcelain repair systems tested in other studies.
Clinical Technique for an In‐Office Porcelain Modification
Authors: Scherer Warren , Putter Harvey , Cooper Harmon
Published: July 2007

All porcelain restorations, especially intra‐ and extracoronal restorations, have become an accepted treatment modality for the esthetic restoration of posterior teeth. One problem with these restorations is the limited ability to modify the porcelain when a proximal contact is not present or there is an open margin. Using a low‐fusing porcelain in a glazing oven, practitioners can easily accomplish such modifications during the try‐in and cementation appointment for porcelain inlays. This technique eliminates the need for returning the porcelain inlay to the laboratory for modification and a second patient visit to complete the restoration. This paper describes an in‐office procedure for modifying porcelain restorations and a scanning electron micrographic evaluation of the etched porcelain surface after using this modification technique.
At‐Home Bleaching System: Effects on Enamel and Cementum
Authors: Scherer Warren , Cooper Harmon , Ziegler Benjamin , Vijayaraghavan T.V.
Published: July 2007

An analysis by scanning electron microscopy was undertaken to investigate the effects of bleaching on enamel‐cementum surface morphology. Teeth were investigated in five groups: control; vital bleached for 5, 15, and 30 days; and 37 percent phosphoric acid gel etched for 20 seconds. Only the gel‐etched group exhibited etching patterns. Shade change in vital bleached teeth was noted in the group vital bleached for 30 days.
Reshaping Tooth Contours with Direct Resins*
Authors: Feigenbaum Norman L.
Published: July 2007

A case is presented that focuses on the diagnosis, treatment plan, and preparation for reshaping tooth contours with direct resin materials.
Principles and Mechanisms of Bonding with Dentin Adhesive Materials
Authors: Kubo Shisei , Finger Werner J. , Müller Michael , Podszun Wolfgang
Published: July 2007

This article reviews six dentin bonding agents with regard to composition of the individual components of each of the systems. Adhesion mechanisms are discussed relative to the chemical compounds mediating the bond. Adjunctly, inspection of the bonding sites between the different adhesives and human dentin by scanning electron microscopy elucidates the bonds formed as far as detail reproduction as an indicator for wetting ability or mechanical interlocking.
Restoration of Maxillary Anterior Teeth Using Porcelain Jacket Crowns and Porcelain Veneers
Authors: Cutbirth Steven T.
Published: July 2007

Combining different types of restorations when restoring maxillary anterior teeth poses a difficult esthetic problem. This article describes a method of restoring maxillary anterior teeth using a combination of porcelain jacket crowns and indirect porcelain laminate veneers.