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The present review analyses the documentation on incidence, diagnosis, risk factors and effects of milk fever and subclinical hypocalcaemia. It is hereby evaluated whether the existing documentation seems sufficient for further modelling in a decision support system for selection of a control strategy. Several studies have been carried out revealing an incidence of milk fever most often in the level of 5-10%. Few studies indicate that the incidence of subclinical hypocalcaemia is several times higher than milk fever. The diagnosis based on clinical or laboratory methods or based on presence of risk factors is outlined. The clinical symptoms of milk fever are highly specific and the disease level may thus be determined from recording of treatments. Diagnosis of subclinical hypocalcaemia needs to include laboratory examinations or it may be determined by multiplying the incidence of milk fever by a certain factor. From the documentation on risk factors, it is very complex to predict the incidence from the exposure level of the risk factors. Due to uncertainty, sensitivity analyses over a wide range of values for each parameter are needed. The documentation of cow characteristics, nutrition, environment and management as risk factors are described. Among cow characteristics, parity or age, body condition and production level were found to be important. Risk factors associated with nutrition included most importantly dietary cation-anion difference and calcium level whereas the importance of general feeding related factors like type of feed stuff and feeding level were less clear. Environment and management included season, climate, housing, pasturing, exercise, length of dry period and prepartum milking. Several of the parameters on environment and management were confounded among each other and therefore firm conclusions on the importance were difficult. The documentation of the effect of milk fever includes the downer cows, reproductive disorders, occurrence of other diseases and the effect on milk production, body weight and culling. The reproductive disorders included most importantly dystocia, uterine prolapse, retained placenta, metritis and repeat breeding, and occurrence of other diseases included ketosis, displaced abomasum and mastitis. The documentation was substantial and often quantifiable within certain limits. Overall it is concluded that the present documentation on milk fever concerning incidence, diagnosis, risk factors and effects seems sufficient for a systematic inclusion in a decision support system. A model on milk fever should take into consideration the variation in biological data and individual herd characteristics. The inclusion of subclinical hypocalcaemia would be more uncertain and probably should await further documentation on possibilities of determining the herd level incidence and also the effect of this condition on production.
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PMID:Milk fever and subclinical hypocalcaemia--an evaluation of parameters on incidence risk, diagnosis, risk factors and biological effects as input for a decision support system for disease control. 1145 89

The high incidence of arrhythmias in patients with heart failure, hypertension, valvular heart disease, or mitral walve prolapse suggests a strong link between wall motion abnormalities and arrhythmias. A potential common mechanism underlying these observations may be that overload leads to electrophysiologic changes and facilitates arrhythmias. This article summarizes the interaction between changes in atrial and ventricular loading conditions and repolarization. Most experimental and clinical studies demonstrated 1) a reduction of action potential duration and refractoriness, 2) development of early afterdepolarizations, and 3) ectopic beats originating from these afterdepolarizations. Discrepancies between studies are related to different study designs, i.e., varying magnitude, velocity, and timing of increased load, the level of repolarization at which action potential duration is measured as well as different animal species. Direct effects of increased load on repolarization are most likely caused by activation of stretch-activated nonselective cation ion channels and changes in calcium handling. Current antiarrhythmic drug therapy is aimed at electrical disorders as the primary cause of arrhythmias. If mechanical disorders play a central role in the genesis of cardiac arrhythmias, future treatment should be directed at restoring a more normal mechanical function of the heart. Additional studies will further clarify the nature and clinical significance of load-related changes in repolarization and arrhythmogenesis.
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PMID:Load-induced changes in repolarization: evidence from experimental and clinical data. 1151 93

Bone defects were created in rabbit medial femoral condyle in a model where subchondral bone was completely removed or about 2 mm of subchondral bone was maintained. Groups without augmentation and augmented with autogenous bone, polymethylmethacrylate, or calcium phosphate cement were sacrificed at 3, 12, and 24 weeks for evaluation of articular cartilage and observation of bone formation. In the model in which subchondral bone was completely removed, collapse of the subchondral bone together with exfoliation and prolapse of cartilage developed early in all cases. In the model in which 2 mm of subchondral bone was maintained, degeneration of articular cartilage developed at 12 weeks in the group augmented with polymethylmethacrylate, showing a significant difference when compared to the contralateral untreated control group. The group augmented with calcium phosphate cement did not demonstrate any evident difference from the control group. Mechanical properties after subchondral replacement did not differ between the groups augmented with polymethylmethacrylate and calcium phosphate cement, although calcium phosphate cement was considered histologically superior. Calcium phosphate cement was a reliable subchondral replacement material when the bone defect is adjacent to the articular cartilage.
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PMID:Effects on articular cartilage of subchondral replacement with polymethylmethacrylate and calcium phosphate cement. 1177 7

Kearns-Sayre syndrome (KSS) is a multisystem mitochondrial disorder characterized by the invariant triad: onset before 20, progressive external ophthalmoplegia and pigmentary retinal degeneration, plus at least one of the following: complete (or not) heart block, cereberal dysfunction and CSF protein above 100 mg/dl. Autopsies from patients with KSS revealed widespread tissue distribution mtDNA deletions. These deletions result in significantly lower activities of the enzymes of the respiratory chain. The same deletion of mitochondrial DNA present in skeletal muscle is found in myocardial tissue. An 18-year-old girl diagnosed with the KSS was admitted to our hospital because of an upper respiratory tract infection and dysphagia. ECG showed cardiac conduction defects. The patient had no history of syncope. At her surface ECG there was a complete RBBB (QRS duration approximately 130 ms), a clockwise rotation with an axis of approximately 90 degrees and a slight QT prolongation (420 ms). Echocardiography showed prolapse with thickening and degeneration of both mitral valve leaflets but without mitral regurgitation. The patient was started on a diet rich in potassium and pharmaceutical therapy with magnesium oxide (240 mg of elemental Mg p.o. per day), 1 g of calcium carbonate t.i.d., vitamin D (calcitriol 0.25 microg p.o. per day) and coenzyme Q(10) 100 mg daily and discharged 6 days later with slightly improved biochemical profile but apparent clinical improvement. Urgent pacemaker implantation was decided but unfortunately the patient died due to acute cardiac arrest 10 days later.
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PMID:Alarming atrioventricular block and mitral valve prolapse in the Kearns-Sayre syndrome. 1200 93

In bony defects of the cranium, bone healing may be complicated by prolapse of surrounding tissue into the defect. This tissue acts as a potential obstruction to the migration of osteogenic cells, resulting in impaired bone formation. It has been shown in previous studies that when a membrane composed of resorbable polymers (LactoSorb) is placed over a cranial bone defect, it inhibits connective tissue from entering the wound and improves the rate and quality of the bony regenerate. This study is an extension of this work and specifically evaluated the effects of differing calcium-based surface coatings on membrane-covered cranial defects in the rabbit model. In non-critical size, full-thickness defects of the mature rabbit calvarium, four differently treated LactoSorb membranes were evaluated in each animal model over a 1-year postoperative period. The surface coatings (three treated, one untreated) consisted of a base-powdered material of calcium sodium phosphate (Osteostim, EBI, NJ), which were applied by different methods (pressed, brushed, one-sided versus two-sided). Evaluation consisted of cross-sectional histologic assessment of the cranial detects determining the quantitative bony fill and the presence of residual polymer material and calcium sodium phosphate. This study produced the following findings: (1) cranial defect regeneration occurs faster with calcium-coated membranes and is complete by 3 months; (2) no difference could be seen between the different methods of calcium sodium phosphate coating; (3) the calcium sodium phosphate coatings did not inhibit resorption of the biodegradable membranes for those systems that had coatings on one side; however, systems completely covered showed delayed resorption; and (4) the calcium sodium phosphate coatings did not produce any inflammatory reactions. These findings suggest that, in addition to inhibiting connective tissue from entering the wound site, the calcium coatings on resorbable devices may have beneficial effects in selected clinical conditions, especially in conditions where faster bone regeneration is necessary.
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PMID:Compartmentalized bone regeneration of cranial defects with biodegradable barriers--effects of calcium sodium phosphate surface coatings on LactoSorb. 1221 98

Buffalo are of high economic importance for farmers in several developing countries but reproductive performance is poor. A large proportion of heifers attain puberty at 3-5 years of age. A good quality diet supplemented with extra nutrients reduces the age of puberty, whereas the effects of administration of exogenous GnRH or equine chorionic gonadotrophin (eCG) are equivocal. The incidence of anoestrus in buffalo ranges from 20 to 80% depending on season. Most buffalo cease ovarian cyclicity during hot summers probably due to the combined effects of nutrition, environment and management. Keeping buffalo cool by wallowing, water sprinklers or shade improves fertility. Supplementary feeding with Urea Molasses Multi-nutrient Blocks (UMMB) for 60 days before calving enhances the early onset of postpartum oestrus. Regular UMMB supplementation also improves pregnancy rates in anoestrous non-pregnant buffalo. Prepartum vaginal prolapse is hereditary and eradication can be achieved by genetic selective breeding programmes. Treatment with calcium, phosphorus and progesterone gives only transient relief to clinical cases. Uterine torsion is the most common cause of dystocia (70%). Deployment of Sharma's detorsion method and anti-stress measures increase survival rates in cases presented within 36 h. In conclusion, greater understanding about the effects of better year-round nutrition, improved management and markers for logical breeding programmes are essential to curtail the incidence of the reproductive disorders that reduce buffalo fertility.
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PMID:Enhancing reproductive performance in dairy buffalo: major constraints and achievements. 1463 24

Numerous studies indicate that opioid tolerance involves a disruption in Ca2+ homeostasis. In vivo studies have indicated the involvement of dihydropyridine-sensitive (L-type) voltage-gated channels in morphine abuse. In this study, the effect of multiple administration of the dihydropyridine calcium channel blocker nifedipine (5 mg/kg/twice daily), given in combination with morphine, on the signs of morphine withdrawal and some biochemical parameters were assessed. Multiple morphine administration in increasing doses (from 5 to 40 mg/kg for 7 days) and consequent withdrawal after 18 h, induced writhing, squealing, diarrhea, teeth chattering, eyelid ptosis and wet-dog type shaking. Coadministration of nifedipine prevented the squealing, diarrhea and teeth chattering. On a biochemical level, the activity of brain nitric oxide synthase (NOS) and the quantity of cytochrome P450 in rat brain and liver were measured. Nifedipine treatment decreased the brain nNOS activity, induced by multiple administration of morphine. The quantity of liver cytochrome P450, after multiple coadministration of morphine and nifedipine, was also increased. The quantity of brain cytochrome P450 was not significantly changed by morphine and nifedipine alone or in combination. The results of our study suggest that nifedipine influences the effects of morphine both at a pharmacokinetic and a pharmacodynamic level.
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PMID:Effects of nifedipine on behavioral and biochemical parameters in rats after multiple morphine administration. 1560 24

Tension-free vaginal tape (TVT), a less-invasive variation of the suburethral sling, has been rapidly gaining popularity worldwide in the treatment of female stress urinary incontinence. We report on two cases of bladder stones composed of fatty acid calcium following TVT operations. Case 1: A 76-year-old woman with a history of hysterectomy due to cervical cancer was suffering from vault prolapse. The insertion of a ring pessary lead to the development of stress urinary incontinence, and she was referred to our hospital. As she was frail, sexually inactive, and elderly, she underwent partial colpocleisis (Le Fort operation) combined with a TVT operation. One-month postoperative videourodynamics and chain cystourethrography (CUG) using olive oil as the lubricant showed cure of incontinence and mild support of the urethra. Her maximum flow rate was 18.8 ml/s and no residual urine was observed. Six months postoperatively she developed postmiction pain and pyuria that were not improved by antibiotics. Cystoscopy showed a small bladder stone, whose removal cured cystitis. Case 2: A 49-year-old woman, with a history of abdominal hysterectomy due to myoma uteri, visited our hospital complaining of stress urinary incontinence. A periurethral collagen injection was only temporarily effective, and she underwent a TVT operation. A 1-month postoperative evaluation including chain CUG using olive oil as the lubricant showed cure of incontinence, mild support of the urethra, a maximum flow rate of 28.8 ml/s, and no residual urine. Two months postoperatively she developed miction pain and pyuria that were solved by removing a small bladder stone. Anti-incontinence surgery increases the risk of developing bladder stones due to either foreign bodies (bladder erosion) or obstruction. However, neither of our cases had these conditions; instead, both bladder stones were composed of fatty acid calcium that appeared to be related to the olive oil used as the lubricant in chain CUG. Only four cases (including ours) of bladder stones composed of fatty acid calcium have been documented, but they may indicate that care is necessary when using olive oil as a contrast medium or lubricant in the urinary tract. When a woman with a history of anti-incontinence surgery has persisting or recurrent cystitis, cystoscopy should be performed to exclude bladder erosion and stones.
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PMID:[Bladder stone caused by olive oil following TVT operation]. 1608 36

Two patients are described, the first with a giant aneurysm of the left carotid bifurcation previously treated by endovascular technique, the second with a bilateral intracavernous aneurysm: both were submitted to high-flow by-pass operation. The first patient was a 40 year-old woman who had presented subarachnoid hemorrhage 6 months before operation. She had been treated by means of a high-flow by-pass between the external carotid artery and the middle cerebral artery. Control angiograms performed 12 hours later showed a stenosis above the suture between the external carotid artery and the venous graft. Angioplasty was performed by endovascular route: new angiograms showed occlusion of the graft while dopplersonography demonstrated the presence of flow within the graft. Angiograms performed 1 week later showed marked vasospasm of the venous graft, of the internal carotid artery, the anterior cerebral artery and the middle cerebral artery. The evolution of spasm of the graft and of the intracranial arterial flow was monitored by dopplersonography and MR-angiography: the latter was performed 20 days after the last angiography and confirmed patency of the graft, while dopplersonography showed resolution of vasospasm. Finally, the aneurysm was embolized. The second patient was a 49 year-old woman with mild left palpebral ptosis and retro-orbital pain. She had already been submitted to high-flow by-pass operation 7 months earlier to treat a right intracavernous aneurysm; the left by-pass was necessary because the intracavernous aneurysm had become symptomatic. One week after surgery, spasm of the venous graft was documented by MR-angiography. In both cases, treatment consisted of calcium antagonists as well as hypertensive and hypervolemic medication, which was successful in treating vasospasm of the venous graft and its symptoms. Spasm of the venous graft, a well-known occurrence in cardiac revascularization, can also be observed in cerebral revascularization.
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PMID:Vasospasm of venous grafts in extra-intracranial by-pass. Report of two cases. 1628 93

Postpartum ovarian activity, uterine involution and plasma concentrations of calcium and 15-keto-13, 14 dihydro-prostaglandin F2alpha (PGFM) were assessed in dairy cows with retained fetal membranes (n=10) and milk fever (n=10) at parturition. In addition, calcium and PGFM were evaluated in dairy cows affected with uterine prolapse (n=10) and pyometra (n=14). Cows with retained fetal membrane averaged 24.2+/-3.7 d until their first postpartum ovulation, while controls averaged 29.0+/-3.7 d (P>0.10). In cows with retained fetal membranes, the difference in follicular activity between the contralateral and ipsilateral ovaries in relation to the previously gravid uterine horn was appreciably greater post partum when compared with that of the controls. Cows with milk fever had an average of 30.8+/-3.1 d until their first postpartum ovulation, while control cows had an average of 20.4+/-3.3 d (P<0.05). The mean diameter of the uterine horns in cows with milk fever was greater (P<0.05) compared with that of the controls between Days 15-32 post partum. Concentrations of plasma calcium were lower in cows with retained fetal membranes within 24 h after parturition and during the first week post partum than in the controls (6.27+/-0.18 vs 7.40+/-0.18 mg/100ml, P<0.05). Concentration of calcium was lower (P<0.05) in cows with milk fever on Day 1 prior to treatment (4.68+/-0.40 < 5.8+/-0.45 mg/100ml) than in control cows; however, the calcium (Ca) level was not different during the subsequent 7 d post partum after treatment. Cows with uterine prolapse had lower concentrations of Ca during the first 7 d post partum than the controls (6.10+/-0.15 vs 7.33+/-0.12mg/100ml; P<0.01). Cows with pyometra had higher (P<0.05) concentrations of plasma PGFM than the controls (208.+/-13.2 > 138.1+/-15.2).
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PMID:Effects of calving-related disorders on prostaglandin, calcium, ovarian activity and uterine involution in postrartum dairy cows. 1672 25


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