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An ELISA test was used to determine the persistence of antibody levels in horses following treatment for Trypanosoma evansi. In 17 horses with T. evansi from two farms treated and cured with quinapyramine sulphate, ELISA antibody levels fell progressively post-treatment, but remained with positive results for 22.6 months in one horse, 12.8 months in a second, 4.1 months in another four and 2.3 months in three, whilst the rest became negative at 2.3 months. In two horses that suffered a post-treatment infection relapse the decrease in ELISA levels was only temporary, and a new increase in antibody levels was proven. The follow-up of these antibody levels could prove useful in clinical cases and in epidemiological studies, as well as for assessing the efficacy of drug treatment.

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Optimum arrhythmia management has evolved to couple ICD therapy with catheter ablative and drug therapy to attempt to eliminate or reduce arrhythmia risk. No longer should the clinician approach such therapy as a choice among single alternative strategies only. Optimum patient management includes not only recognition of the indications and benefits of such hybrid therapy but also a complete understanding of potential pitfalls of such therapy.

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Tritrichomonas foetus infection was investigated in 76 pregnant and 64 non-pregnant cows slaughtered in the local abbattoir and in two different lots of first-service heifers that were found to be non-pregnant 60 days post breeding (PB). In live and slaughtered animals, mucus samples were obtained from the vagina and from the vagina and uterus, respectively, using a "screw-head scraper rod". In pregnant cows, samples of amniotic and allantoid fluid were also collected, as well as samples from the stomach contents of the fetuses. All samples were cultured in Modified Plastridge Medium. T. foetus was isolated from three pregnant and two non-pregnant slaughtered cows. Parasites were recovered from the vagina of these five cows, as well as from the uterus in two cases and from the fetus in one case. Lot I of first-service heifers consisted of 323 females from eight different farms. Bulls infected with T. foetus from these farms were culled or treated, and heifers found empty at diagnosis of pregnancy were culled. Lot II consisted of 120 heifers from a single farm where T. foetus was controlled only in bulls. All heifers from Lot I were T. foetus negative. In Lot II, 12 of 120 heifers (10%) were T. foetus positive. In ten of these the parasites were observed once, in one at 60 days PB, in seven at 160 days PB and in two at 240 days PB; in the remaining two infected heifers, an irregular pattern of isolation persisted during 300 days PB. On the basis of these results, control methods are discussed and analysed.

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BACKGROUND: We surveyed patient attitudes about driving and about driving restrictions for patients with automatic defibrillators and pacemakers, and we assessed risk of arrhythmias occurring during driving. METHODS: One hundred two patients responded to a questionnaire (57 patients with defibrillators and 45 patients with pacemakers) about driving habits and opinions on restriction of patients who have devices and want to drive. In addition, the literature was reviewed for approximate incidences of sudden death and syncopal or nonsyncopal device therapy to estimate risk while driving of having a defibrillator discharge. RESULTS: Thirty-two patients with defibrillators (56%) and 28 patients with pacemakers (62%) currently drove an average of 196 and 161 km/wk, respectively. Most patients felt that driving was a right and 75% felt that restriction imposed a hardship on them. Respondents felt that common sense, limited distances, or physician input should set driving limitations. A minority felt that no restrictions should be placed on these drivers or that they should not drive at all. The risks of sudden death and syncopal and nonsyncopal defibrillator discharge were estimated at 0.0009%, 0.0011%, and 0.0015% per kilometer driven, respectively, based on weekly kilometers and published occurrences of these phenomena. CONCLUSIONS: Patients perceive that driving is their right and that there is a low risk of an arrhythmic event behind the wheel. The estimated risk and published accounts of sudden death support this. However, concurrent medical problems and stresses imposed by driving may increase risk. The physician must make reasonable recommendations to ensure patient and public safety, keeping in mind both state and federal driving regulations and reporting requirements.

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The fungus Curvularia verruculosa, which produces eumycotic mycetomas, was isolated from skin of horses with granulomatous lesions on the legs. The isolation was made in Sabouraud dextrose agar medium. The horses came from Comandante Fontana suburb, Formosa-Argentina. This finding would be the first report of Curvularia in horses in Argentina.

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The fungus Curvularia verruculosa, which produces eumycotic mycetomas, was isolated from skin of horses with granulomatous lesions on the legs. The isolation was made in Sabouraud dextrose agar medium. The horses came from Comandante Fontana suburb, Formosa-Argentina. This finding would be the first report of Curvularia in horses in Argentina.

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The fungus Curvularia verruculosa, which produces eumycotic mycetomas, was isolated from skin of horses with granulomatous lesions on the legs. The isolation was made in Sabouraud dextrose agar medium. The horses came from Comandante Fontana suburb, Formosa-Argentina. This finding would be the first report of Curvularia in horses in Argentina.

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To evaluate the efficacy and safety of oral amiodarone in the treatment of recurrent, sustained, refractory ventricular arrhythmias, rapid high-dose oral loading was used to treat 12 critically ill patients with frequent, sometimes incessant, sustained ventricular arrhythmias refractory to 2 to 6 antiarrhythmic agents. Presenting arrhythmias included sustained monomorphic ventricular tachycardia and ventricular fibrillation associated with cardiac arrests in 6 patients. Patients experienced 2 to 10 episodes (mean 5 +/- 2) of sustained ventricular arrhythmias over a mean period of 6.2 +/- 5.0 days (range 1 to 14) before oral amiodarone was initiated at 1,200 to 1,400 mg/day. This included at least 1 to 4 episodes (mean 2.2 +/- 1.1) within 24 hours before amiodarone. One to 4 antiarrhythmic drugs were administered concurrently during amiodarone loading. Sustained ventricular arrhythmias no longer occurred after a mean of 5.2 days (range 1 to 22) with amiodarone. Arrhythmias were controlled in 4 patients within 24 hours, 5 patients within 48 hours, 7 patients within 4 days and 10 patients within 6 days. Patients experienced a mean of 0.6 +/- 0.8 episodes within 24 hours after amiodarone. Nine patients survived to hospital discharge. No patient had significant adverse effects during high-dose loading. In conclusion, high-dose oral amiodarone loading, when added to previously unsuccessful conventional antiarrhythmic therapy, is safe and often rapidly effective for at least short-term control of frequent, refractory, sustained ventricular arrhythmias.

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Cardiac tamponade, a potentially lethal complication following cardiac surgery, may present either early or late postoperatively and may be difficult to diagnose due to atypical clinical, hemodynamic, or echocardiographic findings. To determine the frequency and clinical features of postoperative cardiac tamponade, we performed a review of 510 consecutive patients who underwent cardiac surgery. The incidence of postoperative cardiac tamponade was 2.0 percent (10/510 patients) and occurred following valvular, bypass, and aortic surgery. Nine of ten patients had either atypical clinical, hemodynamic, and/or echocardiographic findings. The diagnosis of tamponade was made 1 to 30 days (mean = 8.5 days) postoperatively. Presenting symptoms were often mild and nonspecific. Classic signs including hypotension, pulsus paradoxus greater than 12 mm Hg, and elevated jugular venous pressure were present in 7, 6, and 5 patients, respectively. Right heart hemodynamics revealed elevated and equalized diastolic pressures in three of six patients. Two-dimensional echocardiography revealed selective compression of the left ventricle (LV) (four patients), right ventricle (RV) (one patient), left atrium (LA)/RV (one patient), LA/LV (one patient), LA/LV/RV (one patient), all four chambers (one patient), and no diastolic collapse of any chamber (one patient). There was often an absence of anterior pericardial fluid (six patients) with tethering of a portion of the RV to the chest wall anteriorly (five patients). Coagulation parameters were "supratherapeutic" in only three of eight patients who were receiving systemic anticoagulants at the time of diagnosis. The initial diagnosis was confused with congestive heart failure in one patient, pulmonary embolism in three patients, acute myocardial infarction in two patients, and sepsis in one patient. Eight of ten patients survived; all of these patients underwent surgical removal of fluid and/or hematoma in the operating room. We conclude that postoperative tamponade after cardiac surgery may have varied clinical and hemodynamic presentations, often due to selective chamber compression by loculated fluid or clot. Due to its frequently atypical features and presentation that may simulate other disorders, the diagnosis of tamponade should be considered whenever hemodynamic deterioration or signs of low output failure occur in the postcardiotomy patient.

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Pathological gamblers entering a comprehensive treatment program were thoroughly assessed before treatment and 6 months after completion of treatment. The reports of gamblers and collateral informants were highly consistent. Follow-up interviews were conducted with 57 of the 66 patients entering treatment. Total abstinence was reported by 56% (N = 32) of the patients located for follow-up, and significant improvement on a wide range of measures was documented. The authors feel that the results demonstrate that pathological gambling is a treatable mental disorder.

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In 1972 the Brecksville Unit of the Cleveland Veterans Administration Medical Center began the first inpatient treatment program for pathological gambling in the United States. The 30-day, highly structured gambling treatment program aims for abstinence from gambling, reduction of the urge to gamble, and restoration of a maximum level of social functioning. The authors report the results of a preliminary outcome study of 60 former patients who completed a survey form rating various aspects of their lives one year postdischarge. Fifty-five percent of the respondents reported complete abstinence from gambling since discharge. Chi-square analyses demonstrated significant relationships between abstinence from gambling and improved interpersonal relationships, better financial status, decreased depression, and participation in professional aftercare and Gamblers Anonymous. The authors believe that their initial results support the contention that pathological gambling is a treatable disorder.

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Clinical impressions and psychological testing suggest that pathological gamblers demonstrate a high incidence of affective disorders. To assess the frequency of such disorders, the Schedule for Affective Disorders and Schizophrenia was administered to 50 patients admitted successively to the gambling treatment program of a VA hospital. Seventy-six percent of the subjects were diagnosed as having major depressive disorder and 38% as having hypomanic disorder according to the Research Diagnostic Criteria. The patients with major depressive disorder and one patient with schizoaffective disorder, depressed type, were significantly more likely to miss work often due to gambling. A large number of patients displayed suicidal tendencies.

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Increasing public exposure to gambling as a recreational option is leading to increased pathological gambling . The prevalence and correlates of substance abuse in a population of severe pathological gamblers is investigated. The results indicate a high rate of alcohol abuse and drug abuse in this population and in their biological families. The implications of these findings for clinicians working with pathological gamblers and substance abusers are discussed.

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