bluuebunny/crossref_metadata_2025 huggingface dataset:
FC‐54  Evaluation of IgE‐mediated late‐phase reactions in the skin of normal placebo‐ and prednisolone‐treated dogs: cellular, cytokine and chemokine responses
Authors: Pucheu‐Haston C. , Shuster D. , Olivry T. , Brianceau P. , Lockwood P. , Mcclanahan T. , De Waal Malefyt R. , Mattson J. , Hammerberg B.
Published: August 2004

IgE‐mediated late‐phase reactions can be induced in the skin of normal and atopic dogs by intradermal injections of anti‐IgE antibody. The histology of these reactions is very similar to that of naturally occurring atopic dermatitis. To characterize the cellular, cytokine and chemokine responses in the skin of placebo‐ and prednisolone‐treated dogs, normal beagles received either placebo or 0.5 mg/kg prednisolone twice daily for three days prior to intradermal injection of polyclonal rabbit anti‐canine IgE. Eight‐millimetre punch biopsy skin samples were taken before injection and at the injection sites after 6, 24 and 48 h. Histological and immunohistochemical examination revealed a rapid cellular influx. Eosinophil and neutrophil numbers increased from <1 to 61.4 ± 14.1, and from 7 to 62.2 ± 10.8 cells/mm2, respectively, within 6 h after injection, and remained moderately elevated 48 h later. The numbers of CD1c+, CD3+ and CD4+ mononuclear cells were also increased by 6 h. Taqman analysis demonstrated 2.5‐ to 72‐fold increases in mRNA expression for IL‐13, IL‐5, MCP (CCL2), RANTES (CCL5) and TARC (CCL17). Levels of mRNA for IL‐2, IL‐4, IL‐6, and IFNγ remained negligible. Prednisolone administration suppressed the influx of neutrophils and eosinophils, and the expression of IL‐13, CCL2, CCL5 and CCL17 (33, 97, 58, 86, 73 and 90%, respectively), as well as the influx of CD1c+ and CD3+ cells. These data document the cytokine and chemokine response to anti‐IgE injection and demonstrate the anti‐inflammatory effect of prednisolone.

Funding: Schering‐Plough Animal Health.
FC‐55  Efficacy of low‐dose immunotherapy in the treatment of canine atopic dermatitis: a prospective, double‐blinded study
Authors: Colombo S. , Hill P. B. , Shaw D. J. , Thoday K. L.
Published: August 2004

There are anecdotal reports of increased effectiveness of allergen‐specific immunotherapy (ASIT) with doses of vaccine lower than that recommended by the manufacturers. However, no controlled studies have been carried out. The aim of this prospective, double‐blinded study was to evaluate whether induction and maintenance with low‐dose (LD) ASIT resulted in a different success rate compared with the standard dose (SD). Twenty‐seven dogs with confirmed atopic dermatitis were allotted by block randomisation to two groups. One (n = 13) received SD ASIT; the other (n = 14) received LD ASIT (1/10 of the SD) following the same frequency protocol. Cases were graded at 0, 3, 6 and 9 months for clinical signs using a modified Canine Atopic Dermatitis Extent and Severity Index (mCADESI) and for pruritus using a 0–5 descriptor scale. There were no significant differences between the groups in the pruritus and mCADESI scores (P > 0.155) at the end of the study. Changes in pruritus (P > 0.920) and mCADESI (P > 0.296) scores from the beginning to the end of the study were similar in both groups, with pruritus scores in both groups not changing during the study (P > 0.052). However, significant reductions in mCADESI scores were seen in both groups (P < 0.032). Six dogs achieved a final pruritus score of 0, six dogs achieved a reduction in pruritus score, and 15 did not improve or worsened. There was, therefore, no evidence that LD ASIT was more effective than the standard protocol.

Funding: Petsavers, British Small Animal Veterinary Association, Wellcome Trust.
FC‐56  Nodular and non‐nodular focal alopecia related to drug injections: a retrospective study of 32 dogs
Authors: Berrocal A.
Published: August 2004

Cutaneous manifestations of idiosyncratic adverse drug reactions are considered uncommon. These manifestations are the result of unexpected drug effects, independent of dose, and are not related to the known mechanism of action of the drug. The pathogenesis is not well understood and may occur through immunologic or nonimmunologic mechanisms. Several clinical cutaneous manifestations of drug reactions are described: anaphylaxis, immune‐complex formation with or without vasculitis, allergic contact dermatitis, erythema multiforme and injection‐site reactions. Thirty‐two dogs were recorded with focal nodular and non‐nodular alopecia. Skin biopsies were taken from 31 cases for histopathological examination. Cytology was done in the remaining case. Based on clinical information and dermatopathological findings, they were divided into five groups. Group 1 included 17 toys dogs (10 French poodles) with non‐nodular circular alopecia associated with rabies vaccination. Group 2 dogs showed a nodular focal panniculitis and included five dogs (three French poodles); three had received a multivalent vaccine and the other two a rabies vaccine. Group 3 dogs included three females (two Maltese terriers) with circular alopecia related to an injectable progestin. Group 4 included three dogs (a Pekinese, a Shih Tzu and a French poodle) that had received glucocorticoid injections. Group 5 was a miscellaneous group of four dogs; two dogs had received injectable ivermectin, another ketoconazole, and there was no clear indication that the fourth dog had received a drug injection.

Funding: Self‐funded.
FC‐57  Interspecies differences in the percutaneous permeation of substances with various lipophilicities
Authors: Niedorf F. , Netzlaff F. , Schäfer U. , Kietzmann M.
Published: August 2004

In veterinary medicine, the percutaneous permeation of drugs has relevance to therapeutic and forensic problems. It is commonly investigated in Franz diffusion cells using the excised skin of different mammalian species. Drug permeation characteristics through skin are considered to be significantly influenced both by the biochemical constitution of the stratum corneum and by the number and depth of hair follicles. Drug absorbance characteristics thus show a marked interspecies variance. This complicates the comparison of results obtained in different studies using different species. We examined the species influence on permeation parameters of three test compounds with different lipophilicities (benzoic acid, caffeine and testosterone) in Franz diffusion cells under standardized conditions. While testosterone was found to have the highest permeation coefficient, the permeation coefficients of benzoic acid and caffeine were lower and similar in all species. As expected, the absolute permeabilities showed marked interspecies differences, but the order of permeabilities of the test compounds was conserved in all species. The intraindividual coefficient of variation showed no significant difference between the examined species; the interindividual variation was significantly less marked in bovine skin than in other species. We conclude that the skin of different species can be used for the examination of skin permeation. However, results are transferable to other species only if they were obtained under standardized test conditions.

Funding: German Federal Ministry of Education and Research.
FC‐60  The role of a fresh oleaster leaf preparation in healing of experimental wounds in calves: a histopathologic study
Authors: Derakhshanfar A. , Oloumi M. M.
Published: August 2004

Oleaster (Elaeagnus angustifolia) is a small tree that grows throughout Iran. Using smashed tree leaves combined with olive oil is proposed in one ancient Iranian text as a good remedy for wound healing. Our objective was to evaluate this remedy experimentally. The study was carried out in two female 10‐month‐old Holstein calves. An area of 10 × 10 cm on each side of the thorax was surgically prepared and infiltrated with local anaesthetic. Eight uniform skin wounds were created in two rows with an 8‐mm biopsy punch on each prepared area. Each side of an animal was used to evaluate one treatment (Groups 1–4). To make the mixture, fresh oleaster leaves (50 gm) were smashed with a pestle and mixed with olive oil (25 gm). The wounds were treated for 7 days. The wounds of Groups 1–3 were rinsed daily with normal saline, after which the mixture of oleaster and olive oil (Group 1) or only the olive oil (Group 2) was applied. In Group 4, no treatment was applied. All wounds were left open. On day 8, skin biopsies were taken from the wounds for histopathologic study. Group 1 wounds all showed mild granulation tissue, scab formation and complete re‐epithelialization. In Group 2, there was mild granulation tissue, massive scab formation and minimal re‐epithelialization. In Groups 3 and 4, mild granulation tissue, severe scab formation and very limited re‐epithelialization were observed. We conclude that a fresh oleaster leaf preparation can be an effective remedy for wound healing.

Funding: Self‐funded.
FC‐61  The role of a liquorice preparation in healing of experimental wounds in calves: a histopathologic study
Authors: Oloumi M. M. , Derakhshanfar A.
Published: August 2004

Liquorice, a derivative of the root of Glycyrrhizia glabra, has been proposed as a treatment for gastric ulcers. Here, a preparation of liquorice combined with sesame oil was evaluated in experimental wound healing. The study was carried out in two female 10‐month‐old Holstein calves. An area of 10 × 10 cm on each side of the thorax of the animals was surgically prepared and infiltrated with local anaesthetic. Eight uniform skin wounds were created in two rows with an 8‐mm biopsy punch on each prepared area. Each side of an animal was used to evaluate one treatment (Groups 1–4). To make the mixture, powdered and sieved liquorice (16 g) was mixed with sesame oil (36 g) to make a suspension. The wounds were treated for 7 days. The wounds of Groups 1–3 were rinsed daily with normal saline, after which the mixture of liquorice and sesame oil (Group 1) or only the sesame oil (Group 2) was applied to the wounds. In Group 4, no treatment was applied. All wounds were left open. On day 8, skin biopsies were taken from the wounds for histopathologic study. In Group 1, seven wounds (87%) showed moderate granulation tissue, mild scab formation, and complete re‐epithelialization. In Group 2, there was massive scab formation with no granulation tissue and minimal re‐epithelialization. In Groups 3 and 4, mild granulation tissue, severe scab formation and very limited re‐epithelialization were observed. We conclude that a preparation of liquorice and sesame oil can be an effective remedy for wound healing.

Funding: Self‐funded.
FC‐62  Pale sulphonated shale oil exhibits antimicrobial and tissue repairing effects in wound healing
Authors: Gayko G.
Published: August 2004

A proliferation‐promoting effect on keratinocytes as well as increased generation of the wound‐healing factor PDGFαβ could be observed in vitro in the presence of diluted aqueous solutions of pale sulphonated shale oil. Concomitantly, pale sulphonated shale oil exhibits antimicrobial properties against all infectious agents that are relevant in wound infection and delayed healing, including methicillin‐resistant Staphylococcus aureus. Since most antiseptic substances and local antibiotics cause delayed wound healing, pale sulphonated shale oil has special significance in this field. For this reason, a project for development and approval of a medicinal veterinary product for wound healing in horses according to European Community procedures has been started. No approved product for horses is currently available in Europe. In a dose‐finding study, a hydrogel formulation containing 20% pale sulphonated shale oil as the active pharmaceutical ingredient was found to be most efficient in wound healing. In a study on target‐species tolerance in horses, this formulation proved to be well tolerated in long‐term topical application. Case studies from the clinical efficacy trial show a broad profile of action of pale sulfonated shale oil.

Funding: ICHTHYOL‐Gesellschaft.
ISVD‐1  Highlights of the skin immune system
Authors: Affolter V. K.
Published: August 2004

Similar to intestine and pulmonary tissue, skin is in contact with the environment and hence, requires efficient immune surveillance. The concept of skin‐associated lymphoid tissue (SALT) was first introduced in 1978. The skin immune system (SIS) with its cellular and humoral components and the associated draining lymph nodes fulfills the three major functions of the innate and adaptive immune system: (1) induction of the primary immune response; (2) expression of immunity to previously encountered antigens (memory); and (3) avoidance of deleterious immune responses to nonthreatening antigens (tolerance). The cellular components of the SIS include dendritic antigen‐presenting cells (Langerhans cells and dermal dendritic cells), skin‐homing αβ‐T lymphocytes and γδ‐T lymphocytes, keratinocytes and their environment, the microvascular unit (endothelial cells of the dermal postcapillary venules), neural cells and dendritic neural processes, and the draining lymph node with its high endothelial venules. Humoral components of the SIS are defensins, complement components, immunoglobulins, cytokines, chemokines, fibrinolysin, eicosanoids and neuropeptides. Important characteristics and functions of these components and their interactions with each other will be discussed with regard to normal skin versus recruitment phase, retention phase and resolution phase associated with inflammatory conditions. The discussion will primarily focus on cutaneous dendritic antigen‐presenting cells, cutaneous lymphocytes and their homing into the skin, and keratinocytes. Moreover, the importance of the microvascular unit in relation to leukocyte recruitment and migration will be discussed.
ISVD‐2  Chytridiomycosis – an emerging and fatal infectious skin disease of amphibians
Authors: Oevermann A. , Robert N.
Published: August 2004

Chytridiomycosis, a mycotic cutaneous infection of amphibians, was first described in frog populations in Australia and Central America and was consequently found in wild and captive anurans and urodeles worldwide. It is now considered an emerging infectious disease and a key factor in the dramatic global decline of amphibians. The aetiological agent is Batrachochytrium dendrobatidis, a member of the fungal phylum Chytridiomycota in the order Chytridiales. Batrachochytrium dendrobatidis is the first and only chytrid known so far to be pathogenic for vertebrates. The keratinophilic fungus causes significant mortality in postmetamorphic amphibians, while tadpoles are spared. Clinical signs vary depending on species and include abnormal posture, lethargy, behavioural changes, loss of righting reflex, bilateral mydriasis, reddening as well as greyish‐white discolouration of the skin, abnormal sloughing, and occasional erosions and ulcers. Death usually occurs within a few days after the onset of clinical signs. At necropsy, gross lesions are confined to the skin and are characterized by greyish‐white discolouration and thickening and sloughing of the skin with occasional erosions and ulcers, particularly on the extremities and the abdominal and pelvic regions. Histologically, the skin lesions are characterized by marked hyperkeratosis with numerous spherical fungal thalli (zoosporangia) within the thickened keratin layer, irregular epidermal hyperplasia, intercellular oedema, and occasional necrosis of epidermal cells, as well as exocytosis of low to moderate numbers of mainly lymphocytes. A mild inflammatory infiltrate (heterophils, lymphocytes, and macrophages) may be present in the dermis. The pathogenesis of chytridiomycosis is largely unknown. However, it is thought that the epidermal hyperplasia and hyperkeratosis seriously compromise the function of the skin which is essential for respiration, water absorption, regulation of body temperature, and homeostasis of electrolytes and serves as a shield against pathogenic organisms. Diagnosis of chytridiomycosis can be achieved by routine histology. The fungal structures can be readily detected on H&E sections. Microscopic examination of skin scrapings stained with lactophenol is a quick method for detection of B. dendrobatidis on dead and living animals. Electron microscopy, immunohistochemistry, PCR, and fungal culture are useful tools to confirm the diagnosis. Administration of azoles (e.g. fluconazole, itraconazole), baths with formalin/malachite green solution, and elevation of the environmental temperature have been described for treatment.

Funding: Self‐funded.
ISVD‐4  Deep cutaneous ulcerations secondary to atherosclerosis in a hypothyroid dog
Authors: Beco L. , Heimann M.
Published: August 2004

The purpose of this report is to describe the clinical and histopathological characteristics of deep cutaneous ulcerations secondary to atherosclerosis. A 5‐year‐old Dalmatian dog was presented with slowly progressive, slightly puritic, nonpainful skin ulcers involving the lateral tarsus, the inner thigh, and one footpad. The hair coat was greasy, dull and covered by oily scales. The tail was alopecic. The dog was abnormally quiet, bradycardic and had a swollen puffy face. Complete blood count revealed a moderate anaemia, and the chemistry panel revealed a severe hypercholesterolemia (12.03 g/L) and hypertriglyceridemia (7.91 g/L). Endocrine tests unveiled low serum T4 (<4.67 ng/mL) and high endogenous TSH (2.08 ng/mL). Histological examination of skin biopsy specimens demonstrated deep chronic ulcers. Beneath these ulcers, deep dermal and subcutaneous medium to large arteries exhibited variable degrees of sclerosis, multiple foci of lipid deposition, and large foamy lipid‐laden histiocytes infiltrating within the tunica intima and media. Rare neutrophils and lymphocytes occasionally infiltrated the arterial walls. Oral thyroxin supplementation induced rapid changes in the dog's attitude, facial swelling and heart rate. The hair coat improved dramatically and ulcers rapidly healed following treatment implementation. There are only rare descriptions of clinical consequences of atherosclerosis in the veterinary literature. To our knowledge, this is the first report of atherosclerosis‐related cutaneous ulceration in dogs. Atherosclerosis is rare in this species, where it most often occurs secondary to diabetes mellitus and hypothyroidism. Ischaemia induced by atheromatous plaques and secondary thrombosis is likely the cause of the skin ulceration in this patient.

Funding: Self‐funded.
ISVD‐5  Canine leproid granuloma in the northeastern United States
Authors: Mauldin E. A. , Goldschmidt M. H. , Rankin S. C.
Published: August 2004

Four cases of canine leproid granuloma were diagnosed in the spring and summer of 2003 by the Laboratory of Toxicology and Pathology at the University of Pennsylvania School of Veterinary Medicine. All dogs presented with one or more firm, often bilateral, ulcerated nodules on the dorsal ear fold. Excisional biopsies revealed nodular areas of granulomatous to pyogranulomatous inflammation with intracellular acid‐fast bacilli. Two dogs, a 10‐year‐old, neutered male Rottweiler and a 6‐year‐old, spayed female Rottweiler, had no travel history outside of New Jersey and Pennsylvania. A 5‐year‐old, female beagle and a 6‐year‐old, spayed female greyhound travelled throughout the eastern United States, but no travel was reported during the time the lesions developed. Two dogs responded completely to surgical excision. Two dogs required multiple excisional biopsies and oral doxycylcine (5 mg/kg twice daily) or orbifloxacin (10 mg/kg daily) before lesions resolved. Nine additional cases were identified retrospectively since 1991. These included three additional greyhounds, three mixed‐breed dogs, a Chesapeake Bay retriever, an Airedale terrier, and an English springer spaniel. Of the 13 total dogs, 11 had lesions located on the pinna, one on the muzzle, and one on the nasal planum. This is the first documentation of canine leproid granuloma in this region of the United States.

Funding: Self‐funded.
Structure–activity studies on high affinity NOP‐active hexapeptides
Authors: Judd A.K. , Tuttle D.J. , Jones R.W. , Sanchez A. , Polgar W. , Berzetei‐Gurske I. , Toll L.
Published: August 2004

Abstract:  Nociceptin/orphanin FQ (N/OFQ) is a 17 amino acid peptide that is the endogenous ligand for the G‐protein coupled receptor ORL1 (NOP), a member of the opioid receptor family. Although it is clear that this receptor system is involved in a variety of physiologic functions, including analgesia, the precise actions of N/OFQ remain largely uncharacterized. One reason for this has been limited number of high‐affinity ligands to NOP, and particularly the lack of availability of useful specific antagonists. Herein, we describe the pharmacologic activity of a series of modified amino acid containing modifications of the hexapeptide Ac‐RYYRWR‐NH2, with high affinity for NOP. These compounds were tested for binding affinity using [3H]N/OFQ binding to human NOP in CHO cells, and functional activity by measuring stimulation of [35S]GTPγS‐binding in CHO cell membranes. These studies suggest that each Arg of the hexapeptide is required to maintain high‐binding affinity. The peptide maintains high affinity if the Tyr2 or Tyr3 are modified, but at least one of these residues must maintain its hydroxyl group or there is a large decrease in intrinsic activity of the peptide.
Conformation and lytic activity of eumenine mastoparan: a new antimicrobial peptide from wasp venom
Authors: Dos Santos Cabrera M.P. , De Souza B.M. , Fontana R. , Konno K. , Palma M.S. , De Azevedo W.F. , Neto J. Ruggiero
Published: August 2004

Abstract:  Eumenine mastoparan‐AF (EMP‐AF) is a novel membrane active tetradecapeptide recently isolated from the venom of solitary wasp, Anterhynchium flavomarginatum micado. It was reported previously that EMP‐AF peptide presented low cytolytic activities in human erythrocytes and in RBL‐2H3 mast cells. In the present work, we observed that this peptide is able to permeate anionic liposomes, and in less extension also the neutral ones. We present evidences showing that the permeation ability is well correlated with the amount of helical conformation assumed by the peptides in these environments. This peptide also showed a broad‐spectrum inhibitory activity against Gram‐positive and Gram‐negative bacteria. The permeability of liposomes and the antibiotic effect showed a significant reduction when C‐terminus was deamidated (in acidic form). The removal of the three first amino acid residues from the N‐terminus rendered the peptide inactive both in liposomes and in bacteria. The results suggest that the mechanism of action involves a threshold in the accumulation of the peptide at level of cell membrane.
The catalase activity of Nα‐acetyl‐microperoxidase‐8
Authors: Jeng W.‐Y. , Tsai Y.‐H. , Chuang W.‐J.
Published: August 2004

Abstract:  N

α
‐Acetylated microperoxidase‐8 (Ac‐MP‐8) is a water soluble, ferric heme model for peroxidases. We report here that Ac‐MP‐8 catalyzes catalase‐type reaction in addition to peroxidase‐type and cytochrome P450‐type reactions. The catalase activity of Ac‐MP‐8 was determined by the Clark oxygen electrode, which measures the production of oxygen in solution. The Km and kcat of the decomposition of hydrogen peroxide (H2O2) catalyzed by Ac‐MP‐8 are 40.9 mm and 4.1 per s, respectively. The specificity constant (kcat/Km) of Ac‐MP‐8 in catalase‐type reaction of H2O2 is 100.2,/m/s, which is 5‐ to 12‐ and 50‐ to 100‐fold less than those of MPs in cytochrome P450‐type reaction of aniline/H2O2 and peroxidase‐type reaction of o‐methoxyphenol/H2O2, respectively. These results indicate that Ac‐MP‐8 can catalyze three different types of reactions, and the relative catalytic specificities of Ac‐MP‐8 with a histidyl ligand exhibit the following orders: peroxidase‐type > cytochrome P450‐type > catalase‐type reactions. Comparisons of the enzyme activities of Ac‐MP‐8 suggest that the fifth ligands of hemoproteins influence the ratio of the three types of reactions.
Effects of modification at the fifth residue of μ‐conotoxin GIIIA with bulky tags on the electrically stimulated contraction of the rat diaphragm
Authors: Nakamura M. , Ishida Y. , Kohno T. , Sato K. , Oba Y. , Nakamura H.
Published: August 2004

Abstract:  μ‐Conotoxin GIIIA, a peptide toxin from the cone snail, blocks muscle‐type sodium channels. Thr‐5 of μ‐conotoxin GIIIA, located on the opposite side of the active site in the globular molecule, was replaced by Cys to which the bulky tags were attached. The tagged μ‐conotoxin GIIIA derivatives, except for the phospholipid‐tagged one, exerted the biological activity with a potency slightly weaker than natural μ‐conotoxin GIIIA. When the biotinylated tags of various lengths were added, the presence of avidin suppressed the action of the biotinylated toxins of <4 nm, but not with 5 nm. The bulky biotinylated tags are useful as a caliper to measure the depth of receptor sites in the channels.
Synthesis and characterization of human α‐defensins 4‐6
Authors: Wu Z. , Ericksen B. , Tucker K. , Lubkowski J. , Lu W.
Published: August 2004

Abstract:  Human α‐defensins are small, Cys‐rich, cationic proteins expressed predominantly in neutrophils and intestinal epithelia. They play important roles in innate and adaptive immunity against infection. Progress in studying these molecules can be accelerated by access to large quantities of high‐quality materials, which have been obtained mainly from natural sources. Here, we report total synthesis of human α‐defensins 4, 5, and 6, also known as HNP4, HD5, and HD6, using the optimized N,N‐diisopropylethylamine (DIEA) in situ neutralization/2‐(1 H‐benzotriazolyl)‐1,1,3,3‐tetramethyluroniumhexafluorophosphate (HBTU) activation protocol for solid‐phase Boc chemistry. Oxidative folding/disulfide formation was achieved directly using crude peptides, resulting in an overall synthetic yield of 10–16% with high purity. Antimicrobial activity assays were performed with Escherichia coli ATCC 25922 and Staphylococcus aureus ATCC 29213, using colony‐counting methods, and the results demonstrated differential activity against these strains. Our report describes a highly efficient synthetic approach that enables thorough structural and functional studies of these three important immunologic molecules.
Accuracy and clinical usefulness of the near‐patient testing CoaguChek S international normalised ratio monitor in rural medical practice
Authors: Jackson Shane L. , Bereznicki Luke R. , Peterson Gregory M. , Marsden Katherine A. , Jupe David M. L. , Vial Janet H. , Rasiah Rohan L. , Misan Gary , Williams Sharon M.
Published: August 2004

Objective:  To compare the accuracy and clinical usefulness of the near‐patient testing CoaguChek S INR monitor in rural medical practice.

Design, setting and main outcome measures:  General practices were identified through Australian university departments of rural health. Study investigators trained general practitioners and/or practice nurses in the use of the CoaguChek S INR monitor. General practices obtained a fingerprick sample for testing with the INR monitor to compare with conventional pathology testing for accuracy. An evaluation questionnaire was administered to users of the machine to assess ease of use and clinical usefulness.

Results:  A total of 169 patients from 15 general practice sites provided 401 paired (CoaguChek S and laboratory) INR results. The CoaguChek S was found to be accurate when compared to laboratory INR (
r = 0.89), despite complicating variables such as multiple users of the monitor and multiple laboratories used for comparison with the CoaguChek S INR. Overall, 88% of dual INR measurements were within 0.5 INR units of each other. For laboratory INR ≤ 1.9, 2.0–3.5 and ≥ 3.6, 97%, 90% and 57% of readings were within 0.5 INR units, respectively. Clinical agreement occurred 93% and 90% of the time against published expanded and narrow criteria, respectively.

Conclusions:  The routine use of near‐patient testing, with appropriate training and quality assurance programs, has the potential to increase the safety and efficacy of warfarin therapy in rural and remote communities.

What is already known on this subject? :  There is clear evidence of the under use of warfarin in patients with atrial fibrillation (AF) and the under‐use is greatest in rural areas. One of the barriers to the use of warfarin in these areas is the relative lack of access to pathology services for regular international normalised ratio (INR) testing

What does this study add? :  This study demonstrates that the performance of the CoaguChek S INR monitor in the rural general practice setting was excellent. Our results indicate that the CoaguChek S INR monitor has the potential to lead to safer and more effective use of warfarin and therefore to better management of anticoagulated patients in rural and remote areas
Hepatitis C education needs of rural general practitioners working in northern New South Wales
Authors: Fraser John , Alexander Christian , Fisher Karin
Published: August 2004

Objective:  To assess hepatitis C continuing medical education (CME) needs of GPs working in rural northern New South Wales (NSW).

Methods:  Anonymous reply paid postal questionnaires sent to all 634 GPs working in northern NSW in August 2000 with a follow‐up in September 2000. Data were analysed using descriptive and χ

2

statistics for association.

Results:  Two hundred and ninety‐two GPs replied (response rate 46.1%). Sixty‐three per cent of respondents were aware of hepatitis C management protocols. Hepatitis C information was most accessed by reading written material (93%), attending seminars (63%) and using the protocol (57%).

 Rural GPs need to balance hepatitis C education with other competing topics. We found restricted access to CME in rural areas with GPs requesting a greater range of delivery modes.

Conclusions:  GPs have an increasing role in hepatitis C management. Hepatitis C CME must be balanced against GPs’ patient load, interest and competing learning needs.

What is already known on this topic:  Recent Australian policies recommend increasing management of hepatitis C in primary care to improve equity of access of health services.

 Educational resources and protocols have been distributed to all GPs in Australia to support this changing model of care.

 There is limited evidence that interactive CME can change professional behaviour with didactic sessions showing limited impact.

What this paper adds:  Sixty‐three per cent of respondents were aware of hepatitis C management protocols.

 Hepatitis C information was most accessed by reading written material (93%), attending seminars (63%) and using the protocol (57%).

 Rural GPs need to balance hepatitis C education with other competing topics.

 We found restricted access to CME in rural areas with GPs requesting a greater range of delivery modes.
Interactive videoconferencing system for rural health education: A preliminary report
Authors: Newbury Jonathan , McKenzie Warren
Published: August 2004

Object:  To establish a videoconferencing network in a new Rural Clinical School.

Design:  A report on choosing hardware and connecting multiple sites simultaneously.

Setting:  Rural South Australia.

Subjects:  Undergraduate medical, nursing and allied health students.

Interventions:  None.

Main outcome measures:  Establishment of an effective multisite, dual mode videoconferencing system.

Results:  The choice of hardware was simple, but acquiring adequate broadband connection between sites proved difficult.

Conclusions:  Multi‐site meetings for academic and administrative purposes are now routine. Evaluation of the effectiveness of medical education delivery will occur throughout 2004.

What is already known on this subject:  Point to point videoconferencing is an established part of health service delivery in rural Australia. The new rural clinical schools were funded to deliver 50% of the clinical years of medical education in rural settings. Additional information technology funds were offered by the Department of Health and Ageing to support this program.

What does this paper add?:  Progress in establishing a videoconferencing system for health education is described. This system is intended to deliver both data, via electronic white boards, together with audio and video image (i.e. dual mode). Adequate bandwidth connection by Frame Relay technology along copper wires is achievable. A videoconference ‘bridge’ allows multiple sites to interact simultaneously.
Palliative care by nurses in rural and remote practice
Authors: Rosenberg John P. , Canning Debbie F.
Published: August 2004

Objective:  To evaluate the experiences of a group of rural and remote nurses in providing palliative care and to discuss the implications of this evaluation for the development and implementation of professional support strategies.

Design:  Semi‐structured survey comprising 23 items measuring perceptions of the nature of rural and remote practice, the provision of palliative care in these settings and the appropriateness of various professional development strategies; as well as 12 open‐ended questions to obtain qualitative descriptions relating to key concepts in rural and remote practice.

Setting:  Rural and remote communities in the Southern zone of Queensland Health.

Subjects:  Thirty‐one registered and enrolled nurses, all female, who attended a two‐day professional development workshop.

Main outcome measures:  Identification of characteristics of, barriers against and strategies to support the practice of palliative care in rural and remote communities.

Results:  High levels of agreement with key statements relating to issues evident in contemporary literature regarding rural and remote nursing practice; qualitative descriptions show congruence with key statements.

Conclusions:  This evaluation demonstrated congruence between the challenges faced by this group of nurses and those reported in the literature. These nurses identified the importance of peer networking as an integral part of their work, which enhanced their potential as rural and remote palliative care providers.

What is already known:  The issues faced by nurses in rural and remote communities have been described in previous studies. For the most part, these had not specifically targeted the practice of palliative care in this setting. It was not clear whether the practice of palliative care brought distinct challenges to nurses.

What this paper adds:  This paper adds to the growing body of knowledge about the professional development needs of nurses in rural and remote communities in relation to the practice of palliative care. It suggests that the nurses surveyed in this study share many challenges in common with nurses practising rural and remote settings. Palliative care is understood to be an integral part of practice, despite the infrequency of palliative care clients and the diverse roles they carry out. Barriers to professional development related to geographical and professional isolation are shared in common. An imperative emerges to identify professional development strategies that are directly relevant to rural and remote settings, to improve access to professional development resources and to promote sustainable peer support networks.
Dental visits in older Western Australians: A comparison of urban, rural and remote residents
Authors: Adams Claire , Slack‐Smith Linda , Larson Ann , O'Grady Martin
Published: August 2004

Objective:  It has been reported that the aged in rural areas may not access regular dental care. The aim of this study was to describe dental visits for those 60 years of age and older living in urban, rural and remote locations in Western Australia and to determine factors associated with such visits. The main outcome was having had a dental visit in the previous 12 months.

Design:  A cross‐sectional telephone survey was conducted.

Setting:  Urban, rural and remote locations in Western Australia.

Subjects:  A total of 2100 participants, 60 years of age and older.

Results:  The present study demonstrated that people in rural and remote areas of Western Australia had a longer time since their last dental visit than people in urban areas. Within each sex, age, country of birth, income, occupation and education group, the highest proportion of people having attended a dentist in the previous 12 months was in urban areas and the lowest was in remote areas. Controlling for sex, age, education and oral health status, compared to urban residents, rural residents were 14% less likely to have seen a dentist and remote residents were 27% less likely.

Conclusion:  The present study demonstrated that for the aged sector of the Western Australian population, geographical location is a major factor in the frequency of use of dental services and the reasons for dental visits. This raises concerns that improvement of oral health by prevention and early detection of tooth and gum problems is less likely to occur in rural and remote areas than in urban areas.

What is already known on this subject:  Although the existing literature identifies needs of the aged and those in rural areas, there is a lack of data at a level in a state with sufficient sample size to fully investigate use of dental services by the aged.

What does this study add:  The present study contributes to our knowledge of the ways that rurality affects the demand for and utilisation of dental services by the aged in this sparsely populated state.
Unusual case of skull metastasis from hepatocellular carcinoma
Authors: Chan Chow Huat (Patrick) , Trost Nicholas , McKelvie Penny , Rophael John A. , Murphy Michael A.
Published: August 2004

Hepatocellular carcinoma with a skull metastasis is a rare clinical entity especially in Western countries. The authors of the present article report a case of solitary skull metastasis from hepatocellular carcinoma in a 75‐year‐old lady who had no prior history of the primary disease or liver dysfunction. The clinicopathological and radiological features are reviewed and discussed.
Mycobacterium fortuitum: an iatrogenic cause of soft tissue infection in surgery
Authors: Muthusami John C. , Vyas Frederick L. , Mukundan Umadevi , Jesudason Mark Ranjan , Govil Sanjay , Jesudason S. R. Banerjee
Published: August 2004

Background:  
Mycobacterium fortuitum is an uncommon cause of soft tissue infections. Treatment is often inadequate with persistence of infection unless the aetiological agent and its antibiotic sensitivity are accurately established.

Methods:  Medical records of 23 patients with chronic soft tissue infection caused by M. fortuitum over a 12‐year period from 1991 to 2002 were studied.

Results:  In 20 patients the cause was iatrogenic, following intramuscular injections (12), laparoscopy (5) and other surgical procedures (3) and in three patients discharging sinuses developed spontaneously. Patients presented with recurrent abscesses or chronic discharging sinuses that did not respond to conventional surgical drainage. The diagnosis was established by isolating M. fortuitum from the tissues in all cases. The treatment consisted of a more aggressive surgical intervention in form of excision, debridement and extensive lay open with curettage and prolonged administration of appropriate antibiotics. The organism showed maximum sensitivity to amikacin and ciprofloxacin. Healing occurred in all cases. Three patients suffered recurrences: two responded to further debridement and antibiotics and are well at 2 and 5 years, respectively.

Conclusion:  A high index of suspicion based on clinical presentation is essential to diagnose M. fortuitum as a cause of soft tissue infection. Treatment involves aggressive surgical debridement and administration of combination antibiotics based on sensitivity, which should be continued for a period that will ensure complete healing and prevent recurrence.
Management of cystic tumours of the pancreas
Authors: McKay Damian , Marron Conor , Mathew Sajjan , Diamond Thomas
Published: August 2004

Background:  Cystic tumours of the pancreas account for 5% of pancreatic neoplasms and are frequently misdiagnosed as pancreatic pseudocysts. The authors’ experience of managing these tumours is presented here, highlighting the clinical presentation, diagnostic difficulties and operative treatment.

Methods:  This is a retrospective study of all patients diagnosed to have cystic tumours of the pancreas treated at The Mater Hospital, during a 5‐year period from 1997 to 2002. Literature was reviewed and guidelines for the management of these tumours have been outlined.

Results:  Seven patients with cystic pancreatic tumours were treated over this time‐period. All patients were women with a median age of 40. Two of these patients were initially diagnosed as having pseudocysts and were treated elsewhere by cystgastrostomy. The tumour was resected in all patients. All but one was benign. At follow up, ranging from 13 to 66 months, all patients were alive and well.

Conclusions:  Cystic tumours of the pancreas are uncommon and generally slow growing. It is important not to assume that a cystic lesion in the pancreas, especially in middle‐aged women, is a pseudocyst. Satisfactory surgical resection may be possible even after previous operative procedures on the pancreas. Prognosis after resection remains good.
Lower gastrointestinal haemorrhage and superselective angiographic embolization
Authors: Burgess Adele N. , Evans Peter M.
Published: August 2004

Background:
 
Little information is available in the surgical literature regarding the use of superselective embolization for bleeding with its origin distal to the ligament of Treitz. The outcome of this treatment remains, to some extent, an unknown. The present paper evaluates the Alfred Hospital's experience using superselective transcatheter embolization in the treatment of acute lower gastrointestinal haemorrhage.

Methods:  An uncontrolled case series analysis was undertaken of all 15 patients who underwent arterial embolization for lower gastrointestinal bleeding, defined as distal to the ligament of Treitz, from July 1998 to January 2003 at the Alfred Hospital, Victoria.

Results:  Transcatheter embolization achieved satisfactory haemostasis in 14 out of 15 patients (93%). Eight patients had rebleeding within 24 h of the initial procedure (53.3%). Two groups of patients emerged: 10 patients who had active bleeding identified on angiography (67%) and five patients whose angiograms failed to find an active bleeding site (33%). Ten per cent of patients with active bleeding observed on angiogram developed bowel ischaemia and 20% died from ischaemia or continued bleeding. Patients without active bleeding identified at the time of angiogram had a proven ischaemia rate of 60% and a 60% mortality rate from continued bleeding or intestinal ischaemia.

Conclusion:
 
High‐risk patients, with active bleeding identified on angiography, can be successfully treated by superselective angiographic embolization and this appears to be an acceptable alternative to emergency resection. If active bleeding is not identified angiographically embolization is not recommended.
Competency‐based training of basic trainees using human cadavers
Authors: Wong Kenneth , Stewart Fiona
Published: August 2004

Background:  Increasing constraints on operative training in the clinical setting provide impetus for the development of alternative training models. Anatomy dissection courses utilizing human cadavers have been useful in imparting knowledge of human anatomy for surgical trainees. The present study evaluates the impact of competency‐based technical skills instruction as an adjunct to cadaveric dissection courses on the procedural skills of basic surgical trainees (BST).

Methods:  A single cohort of BST was prospectively evaluated regarding their self‐reported confidence and competency in performing saphenous vein cutdowns immediately before and after an anatomy dissection course.

Results:  Nine BST were evaluated (66% were male). One subject withdrew from the study, leaving eight BST for final analysis. Mean number of years since graduation from medical school was 2.5 years (range: 2−4 years). Seven BST were in their first year of training. All subjects had completed an early management of severe trauma (EMST) course. Total prior experience of saphenous vein cutdowns for all subjects was a single attempt on a sheep cadaver at the EMST course. The percentage of BST expressing little or no confidence in performing cutdowns decreased after the dissection course (50% vs 0, P < 0.05). Mean time taken for completion of cutdown decreased after the dissection course. (5 min 52 s vs 3 min 52 s, P < 0.05). Mean size of incision used to perform cutdown decreased after the course. (4.5 cm vs 3.4 cm, P < 0.05). The percentage of subjects experiencing complications during cutdown decreased after the course (38% vs 0, P < 0.05).

Conclusions:  Anatomy dissection courses using human cadavers may contribute to improving the confidence and competency of BST in performing saphenous vein cutdowns. Technical training components should be considered as an adjunct to future anatomy dissection courses involving surgical trainees.
N‐Acetylcysteine in intestinal reperfusion injury: an experimental study in rats
Authors: Hazinedaroglu Selcuk M. , Dulger Ferda , Kayaoglu Huseyin A. , Pehlivan Mevlut , Serinsoz Ebru , Canbolat Orhan , Erverdi Nezih
Published: August 2004

Background:  The aim of the present study was to investigate the effect of N‐acetylcysteine on intestinal reperfusion injury.

Methods:  Forty Spraque–Dawley rats were divided into four groups (n = 10): sham, sham + N‐acetylcysteine, reperfusion, and reperfusion + N‐acetylcysteine. Thirty minutes of ischaemia ± 30 min of reperfusion was performed under 100 mg/kg N‐acetylcysteine or placebo, administered 30 min before the operation in the groups where appropriate. Ileum samples were resected for histopathologic evaluation and tissue malondialdehyde and super oxide dismutase level determination.

Results:  The mean mucosal injury score and malondialdehyde level of the reperfusion and reperfusion + N‐acetylcysteine groups were significantly higher than that of the control and control + N‐acetylcysteine group (P < 0.01, P < 0.05, respectively). Mean super oxide dismutase level of the control + N‐acetylcysteine group was significantly higher than that of the other groups (P < 0.05).

Conclusion:  
N‐Acetylcysteine did not prevent intestinal reperfusion injury by means of histopathologic findings and malondialdehyde level.