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Advances in Modern Medicine introduces recent advanced medical practices performed at the Kure Medical Center and Chugoku Cancer Center (KMCCCC) - one of the leading hospitals in Japan - to those working in the field of medicine throughout the world, including physicians, surgeons, pharmacists, psychologists, medical engineers, medical technologists, nurses, and students. Readers will be updated on the general trends in modern medicine relevant to a variety of medical specialties performed at KMCCCC. The volume covers topics such as cancer management, acute phase reaction against a national-level disaster, depression management, emergency medicine, hepatobiliary and gastrointestinal diseases, orthopedics, organ transportation, infection control, blood disease, chronic kidney disease, palliative care, dermatology, ophthalmology, pathology, and nursing for cancer patients. Aspiring medical students can learn more about the latest developments in their field of interest, while patients can learn about treatment options available for different diseases.
Electronic medical records may be the greatest public health innovation of our time. This outcome will be as remarkable as it is welcome, because public health is not the reason the United States is preparing to spend billions of dollars on these records. Public health systems have always depended on clinicians to identify and report important problems. Some reporting is required (such as cases of tuberculosis, sexually transmitted diseases, and measles/mumps/rubella) and some is optional (such as counts of cases of influenza-like illness). But so many reports are never submitted, or arrive late, or lack essential information. As a result, public health action never occurs, or occurs late, or is misdirected. So few physicians report influenza-like illness that large segments of the US population go without timely information. Public health agencies currently use several kinds of electronic health information that originate in the private delivery system. Electronic laboratory reporting identifies conditions for which laboratory reports are sufficient, such as culture-positive tuberculosis. The CDC's BioSense program uses electronic health information from hospitals to look for early evidence of disease clusters. As useful as these approaches are, they fail to capture critical information, ranging from the address of a patient with a communicable condition (laboratories rarely have patients’ addresses), to historical information (prior positive serologies), to diagnoses made or treatments administered in the ambulatory setting. There is much to learn from electronic health records in ambulatory care settings, as this issue's article by Jick et al makes clear.1 Looking back, they were able to observe the origin and spread of a multiyear national outbreak of mumps in the United Kingdom. Since this information was available in real time in electronic medical records, in principle it could have been used in real time to help guide public health response. The CDC's National Center for Public Health Informatics has funded demonstration projects to support real-time surveillance using electronic records in ambulatory practices. These demonstrations include both notifiable disease surveillance, which requires individual reports (www.cdc.gov/mmwr/preview/mmwrhtml/mm5714a4.htm), and syndromic surveillance, which collects counts—for example, to monitor influenza-like illness or for early detection of bioterrorism events.2 Notably, such systems can use distributed analysis methods to allow the clinicians (or the covered entities that collect protected health information) to retain all but specific data elements that serve an essential public health purpose. For instance, it is not necessary to report all positive hepatitis B virus antigen results, since only a minority of infected individuals have acute infection and should be reported. Nor is it necessary to report each person with influenza-like illness when counts by age and sex are sufficient. Another appealing feature of these systems is the capability of the same infrastructure to support other needs, including detection of noninfectious conditions of public health importance, such as diabetes and prediabetes. Many of these measures are also of interest to clinicians, who can use the data to target practice management activities. These functions are well within the capabilities of electronic medical records. What is needed, then, to make electronic medical records an effective public health resource? First, the organizations that set standards for clinical data exchange and the public health community must ensure that standard data formats are readily usable for public health purposes. In principle, any standard should be acceptable. In practice, some standards will be better for this purpose than others. Second, the public health community will need to adopt definitions that can use electronic medical record information and then keep these definitions current. Broadly accepted definitions that are suitable for electronic medical record data are only now beginning to be developed. Third, public health functions must be kept separate from other clinical information activities, both to relieve electronic medical record vendors of the obligation to satisfy ever-changing requirements, and to reduce the operational burden on clinical systems. This can be accomplished by bundling the public health functions into companion software that operates on exported data. For large practices and health information exchanges this may require stand-alone hardware. For small practices, the public health software could coexist on the same hardware platform as the electronic medical record. It will be ideal if vendors could bundle public health software with their products, but this is not necessary. Finally, public health funding will be required to build, disseminate, and sustain these activities. The needed planning and investment will be small in comparison with the expenditure we are about to make in the United States as electronic medical records make their way into routine clinical practice. It is a small price to pay to create a new foundation for public health. ABOUT THE AUTHOR RICHARD PLATT, is Professor and Chair of the Harvard Medical School Department of Ambulatory Care and Prevention at Harvard Pilgrim Health Care. He is Principal Investigator of a CDC Center of Excellence in Public Health Informatics.
Inoculation of the udders of cows with the virus of enzootic abortion of ewes resulted in a severe acute mastitis. The mastitis was characterized clinically by pyrexia, anorexia, decreased milk production, swelling and marked alteration in the physical quality of the milk. The basic lesion was necrosis of alveolar and duct epithelial cells. Virus particles were demonstrated in all levels of the mammary gland three days after inoculation illustrating the rapid spread of the agent. Cells resembling Reed-Sternberg cells and similar to those seen in experimental mastitis produced by the virus of infectious bovine rhinotracheitis were seen in tissues collected six and nine days after inoculation.
A convenient technique is described for the preparation and surgical implantation of permanent cannulae into the lateral ventricles of the rat brain, as well as a method for radiographic confirmation of the location of the implanted cannula. The modified implantation method described is simple, rapid and has produced low mortality in the surgically altered animals.
Free amino acid pattern has been studied in rice moth larvae during aflatoxicosis and compared with normal in ground nut meal and wheat bran. It was observed that there is an increase in free amino acids in intoxicated larvae and this was directly proportional to the degree of toxicity as indicated by decrease in growth of these larvae. The study of excretary pattern of amino acids shows that intoxicated larvae excrete less amino acids than the normal larvae. The results have been discussed.
A practical culture medium which allows direct plating of milk samples for detection and differentiation of Streptococcus agalactiae within 48 hours is described. Most other micro-organisms likely to be present in these samples are inhibited. Although some strains of Staphylococcus species and ofStreptococcus faecalis are able to grow, they may be differentiated on the basis of reaction in the medium surrounding the colonies.
Serial ova count studies were conducted to determine some of the characteristics of the spring rise in faecal shedding of nematode ova by parasitized sheep in flocks in the Montreal area. It was discovered that substantial spring rises occurred in most ewes following their lambing but that great variation existed in the magnitude, duration, and pattern of the rises. Although rams did not display increased ova counts, a slight but well-defined rise developed in one unbred ewe. Larval studies in ewes parasitized by a variety of nematode species, revealed that Haemonchus contortus was the major contributor to the spring rise in faecal ova output. Preparturient treatment of ewes with thiabendazole(1), at the rate of 100 mg./kg. of body weight, suppressed spring rise but failed to arrest completely the faecal shedding of nematode ova.
Nine white-tailed deer and six sheep were experimentally exposed to the California BTV-8 strain of bluetongue virus. The infections were fatal for seven of the nine deer. An additional deer died from exposure to an isolate of bluetongue virus from bighorn sheep. Clinical signs and lesions of bluetongue in deer were described. The incubation period, signs and lesions of bluetongue and epizootic hemorrhagic disease of deer appear to be similar. Virus isolations were made from the blood and a variety of tissues of exposed deer and identified as bluetongue virus. Neutralizing antibodies were detected in all of the convalescent sera.
A five and one-half year old deer (Odocoileus virginianus) developed an ankylosing periarticular hypertrophic arthritis due to a coagulase positive staphylococcus infection. Complete encasement of the tibio-tarsal (hock) joints with a hypertrophic, and porous osseous mass had occurred with complete loss of articular cartilage. The pathologic alterations of the tissues are compared to those occurring in swine due to Erysipelothrix insidiosa infection which produces a rheumatoid-like arthritis.
An apparent relationship between locoism and lathyrism was investigated. Similarities reported in the literature in botanical relationship, signs produced in affected animals, and chemical characteristics were noted. It was demonstrated that the known lathyrogens, aminoacetonitrile and alpha, gamma-diaminobutyric acid, as well as an extract from the loco plant (expected to contain lathyrogens if present in the plant) produced many of the abortive, teratogenic and neurologic effects and signs evident in animals in true locoism. Preliminary assay of extracts from the plant suggested the presence of lathyrogens in the loco plant.
The purpose of Canada's Food and Drug Directorate is to act on behalf of the public to ensure that the drugs and medical devices sold and distributed in Canada are safe, effective and properly represented. The members of the professional staff of the Directorate assist in protecting the consumer from hazardous and fraudulent products represented for the diagnosis, treatment, mitigation or prevention of disease, or the symptoms thereof, in man or animals. To meet these responsibilities, the Directorate's Bureau of Scientific Advisory Services evaluates and interprets all available scientific data relative to any potentially marketable drug, from its industrial synthesis to its metabolic fate; it maintains surveillance and a record of clinical experiences with respect to adverse reactions encountered using drugs already being marketed; and also supplies the Di-
In the present investigation 42 female ferrets were studied in regard to the influence of canine distemper in this species on gastric acid secretion. A total of fifteen naturally-infected and 27 non-infected ferrets were fasted and pylorus-ligated, and were either injected with corticosterone (10 or 50 mg/kg, s.c. one injection/day for 4 days) suspended in corn oil, injected with corn oil, on non-injected. Prior to autopsy blood samples were acquired for corticosterone analysis, and at autopsy the volume, pH, free and combined acidity of the gastric contents were evaluated. It was apparent that distemper induced hypochlorhydria in ferrets under the conditions of these experiments, an effect which was probably mediated through the central nervous system, but may also relate to a direct effect of distemper virus upon the gastric mucosa. Administration of corticosterone did not prevent hypochlorhydria in distemperous ferrets. Blood levels of corticosterone were elevated due to the stress effect of distemper infection, and also as a reflection of exogenous corticosterone administration. Prior immunization against canine distemper failed to immunize the ferrets in this study against the natural precipitation of this disease.
For many years the North American continent has remained relatively free of the serious animal plagues which have hampered the livestock industry in many other parts of the world. This situation may be credited mainly to two factors. The first was the foresight of early Canadian workers in animal diseases who saw the need for the establishment of quarantine stations. The earliest such station to be established on this continent was at Levis, Quebec, almost one hundred years ago. The second factor was the geographic isolation of North America from the rest of the world. The long sea voyage required to bring animals to this country provided ample time for a disease to incubate and, thus, become evident before the animals reached our shores.
Veterinary clinicians can make a significant contribution to the knowledge of the practical value of using alternative treatment methods by conducting clinical trials. By following a logical sequence of steps the clinician can design and participate in a clinical trial in his clinic without interfering with his normal practice. The successive stages of a field trial were presented along with an example to demonstrate the application of the principles involved. These stages are: design and planning, implementation, collection of data, and analysis of data.The veterinary clinician who initiates clinical trials to answer questions plaguing him provides two services to the veterinary profession. First, he helps answer questions facing private practitioners throughout the profession. Second, he can demonstrate that not all research must be done in a laboratory setting isolated from "real world" complications. Seeing the results that can be derived from individual practicing veterinarians participating in clinical trials should act as a stimulus to other veterinarians to logically organize the data coming from their practices.
Reports of Cl. perfringens as a pathogen for cattle are reviewed and discussed.
Of 345 market chicken carcasses received directly from selected processing plants across Canada, six yielded salmonellae. One of the plants submitted 122 carcasses none of which yielded these organisms. A second plant had one Salmonella-contaminated carcass among 20 which were examined. Each of these two plants was subected to detailed bacteriological examinations on four occasions. In these detailed examinations a total of 175 samples or specimens for culture were taken from a variety of surfaces including vent areas of carcasses, operators' hands, equipment surfaces and from water in tanks of iced birds. Twenty-five (14 per cent) of the cultures yielded salmonellae and all but one of these were either S. oranienburg or S. infantis. Isolations were made during five of the eight series of examinations. The evidence indicated that Salmonella-infected flocks were frequently slaughtered and that Salmonella contamination could become widespread in the plant during processing. The organisms are apparently eliminated from all but a small percentage of the carcasses during processing but opportunities exist for recontamination during subsequent handling.
The fluorescent-antibody technique was employed for the detection of bluetongue virus in bovine foetal kidney cell cultures inoculated with tissues and blood from experimentally infected animals. In the first series, a total number of 79 inoculated suckling-mouse brains were examined, 36 as frozen sections alone and 43 as impression slides in conjunction with tissue culture inoculation of the same material. With the combined tissue culture immunofluorescent methods, 36 suspicious were detected by impression smears and 37 positives by the tissue culture out of 43 brains examined. Twenty-two were suspicious out of the 36 examined as frozen sections. Results obtained with the second series, using sheep tissues, showed that the combined tissue culture-fluorescent antibody method was satisfactory for demonstrating the virus in blood of infected animals 1 to 9 days postinfection, and in some organs after death. No false positive reactions were obtained.
The paper describes the changes in P, QRS and T vector orientations in the H plane in the aberrant beats in cases of partial atrioventricular block and premature atrial and ventricular systoles. The sites of possible atrial ectopic foci are discussed in relation to the anatomy of the atrial chambers and the orientation of the P vectors associated with atrial ectopic beats.
Poloxalene, a nonionic surfactant, was fed to beef cattle on a legume ration or a high grain ration to observe its effect on bloat. It was also fed to lactating dairy cows to note any effect on yield or composition of milk. Poloxalene was beneficial in the prevention of bloat with both legume and grain rations. It had no effect on per cent fat, protein, solids-not-fat, or yield of milk.
