Rosenthaldall9462
Hand surgery in Germany has been subject to structural changes that strongly affect the balance between medicine and economics. On the one hand there is a shift of elective hand surgery from the inpatient to the outpatient sector. On the other hand - so our observations - emergency hand trauma cases are more concentrated in bigger hospitals. Given this background there is a lack of statistical data on the management of hand trauma care and treatment of patients with hand injuries. This article discusses a 10-year-analysis of hand traumatological cases treated at a maximum care hospital regarding epidemiological, structural and economic aspects.
Using a database query using ICD codes, inpatient hand trauma cases were identified between 2009-2018 and analyzed with regard to epidemiological and economic indicators (age, gender, comorbidities, case-mix-index (CMI), revenue, length of stay, length of surgery) using PIVOT tables. Patients under the age of 16 years, forearm fractures and intensive care patients for hand injuries while in smaller hospitals care for emergency hand trauma cases is progressively reduced. However, hand injuries may be worth a second thought for economic reasons because they can create reasonable revenues with rather little effort.If a critical number of patients is exceeded, costs of service provisions can be significantly amortized by the proceed generated by treatment. In those hospitals still taking care for acute hand injuries the workload especially in standby duty increased. What may have a negative input on the numbers of treated elective hand surgery cases.Infestation with Tropilaelaps mites is a disease that damages the bee brood and is subject to compulsory notification for Apis mellifera. Despite the high risk of introduction of this disease, it is not yet present in Europe. In order to prevent introduction and spreading, mites of Tropilaelaps size must be identified immediately when found in debris or in covered bee brood. In the present case, Parasitellus fucorum was identified as an additional mite species in the debris of Apis mellifera possessing a potential for misperception as Tropilaelaps spp.Following the accidental feeding of a compound feed containing the coccidiostat nicarbacin in layer breeder flocks (Lohmann Brown Classic), the birds displayed distinct clinical signs within a few hours. Mortality increased during the following 5 days, whereas laying performance and hatching rate of eggs during this period decreased markedly. Egg shell discoloration was observed as early as during the first day. As a consequence, an association between feeding of the coccidiostat nicarbacin and the observed symptoms was assumed. Recent studies indicate that Nicarbacin reduces the activity of aminolevulinic acid synthase type 1 (ALAS 1), which is responsible for the synthesis of protoporphyrin IX in the shell gland as main compound of brown egg shells. Reduced laying performance and increased mortality was likely due to nicarbacin-induced deregulated body temperature homeostasis and concomitant imbalances in acid-base status of the animals. The case reveals that the accidental feeding of nicarbacin to non-target animals such as laying hens and their parents may result in acute clinical symptoms. This highlights the necessity of appropriate care in handling feed additives and their premixes for specific non-target animals and should sensitize farmers and veterinarians.Uroperitoneum is a typical disease in newborn foals. SU11274 research buy An accumulation of urine develops in the abdominal cavity in consequence to a congenital or acquired leakage in the urinary tract. Colts are more frequently affected than fillies. The most common cause of uroperitoneum is a rupture of the dorsal urinary bladder wall. The urinary bladder is affected in 73.1 %, the urachus in 21.6 % and the ureter in 5.2 % of cases. Typical clinical signs occur 2-5 days postpartum, and encompass reduced general condition, abdominal distention, mild colic symptoms and unphysiologic micturition. Ultrasound examination in conjunction with abdominocentesis is considered as the gold standard of diagnostics. Typical laboratory findings are azotemia, metabolic acidosis as well as electrolyte imbalances, particularly hyperkalemia, hyponatriemia and hypochloridemia. Surgical treatment is the only reasonable therapy. Preoperative metabolic disorders and electrolyte abnormalities should be corrected prior to surgery. Especially hyperkalemia leads to a high potential for complications during general anesthesia. Following effective perioperative stabilization, the presence of a defect in the bladder wall or the urachus carries a good prognosis. In total, 63.6 % of the affected foals are healed. Most common complication is a recurrence of uroperitoneum caused by disruption of the suture line or an incomplete closure of the defect.
Chemical restraint in dairy calves is necessary to enable diagnostic and surgical procedures. It is unclear whether xylazine or detomidine differ with regard to desirable and unwanted effects.
In a prospective randomized interventional study, 10 healthy Holstein-Friesian calves (age range 3-6 month) were sedated with either xylazine (0.1 mg/kg, Group X, n = 5) or detomidine (0.03 mg/kg, Group D, n = 5) intravenously, followed by butorphanol (0.1 mg/kg i. v.) in all animals. Characteristics of sedation and selected pharmacodynamic parameters were compared between groups using a non-parametric Mann-Whitney U test.
All calves (5/5) in Group X and (3/5) calves in Group D became laterally recumbent within 5 minutes. Two calves (40 %) in Group D remained standing and could not been positioned in lateral recumbency 15 minutes after initial administration of the sedation agents. Sedation scores, onset and duration of sedation did not differ between groups. Heart and respiratory rate decreased in both groups. Mean arterial pressure was with around 30 mmHg significantly higher in Group D (t
, t
, t
, t
with p = 0.018, 0.036, 0.029 and 0.016, respectively). In Group X, glucose level (t
) and packed cell volume (t
) were significantly lower (p = 0.032 and 0.048, respectively).
and clinical relevance The xylazine-butorphanol combination provided reliable recumbent chemical restraint. With detomidine-butorphanol recumbency failed in some individuals, but a sufficient clinical sedation was achieved. Based on the limited monitoring used in this study, the side effects are of minor clinical relevance in healthy individuals.
and clinical relevance The xylazine-butorphanol combination provided reliable recumbent chemical restraint. With detomidine-butorphanol recumbency failed in some individuals, but a sufficient clinical sedation was achieved. Based on the limited monitoring used in this study, the side effects are of minor clinical relevance in healthy individuals.
