Leptospirosis in cattle

From abnormal milk of cows an agent has been transmitted to guinea pigs, rabbits, mice, and embryonated eggs. This agent caused a febrile reaction in guinea pigs and rabbits and an inapparent infection in mice. In early passages embryonated eggs were unaffected but later death of embryos occurred 7 days after inoculation. When blood from infected guinea pigs or chorioallantoic fluid from infected eggs was inoculated subcutaneously or intranasally into young calves, fever with albuminuria and more rarely hemoglobinuria was produced, in lactating cows the infection resembled that seen in animals with natural disease. Pen contact of normal cows and calves with infected calves resulted in inapparent infection. Autopsies showed that in addition to causing altered milk secretion, the agent damaged the kidneys and produced an interstitial nephritis. The agent was recovered from blood and milk during the febrile period and was demonstrated in the urine for periods long afterwards. Antibodies for the spirochete were found in the sera of experimental animals and of cows recovered from the natural disease. The blood of infected guinea pigs, the chorioallantoic fluid from infected eggs, and the blood or urine from experimentally infected calves yielded a culture of a spirochete which appeared identical with the infective agent in comparative tests of physical, pathogenic, and immunological properties.     

Chronic kidney disease and its complications

Chronic kidney disease (CKD) is a complex disease affecting more than 20 million individuals in the United States. Progression of CKD is associated with a number of serious complications, including increased incidence of cardiovascular disease, hyperlipidemia, anemia, and metabolic bone disease. CKD patients should be assessed for the presence of these complications and receive optimal treatment to reduce their morbidity and mortality. A multidisciplinary approach is required to accomplish this goal.     

Diabetes mellitus and its chronic complications

Diabetes mellitus is a major cause of morbidity and mortality, and it is a major risk factor for early onset of coronary heart disease. Complications of diabetes are retinopathy, nephropathy, and peripheral neuropathy. Currently, treatment involves diet modification, weight reduction, exercise, oral medications, and insulin. In recent years, important advances have been made into the pathogenesis of diabetes that affect the cardiovascular, renal, and nervous systems; vision; and the lower extremities, especially the feet. The progression of diabetic retinopathy and nephropathy can be slowed or prevented with tight glucose and blood pressure control. Neuropathy remains a major problem causing significant impairment. Ongoing clinical trials and testing of various medications to determine their effectiveness in treating the complications of diabetes have met with some success, but there still is much to learn about this disease.     

Respiratory Failure in Leptospirosis

We report on four cases of leptospirosis with pulmonary manifestationsas their presenting features. With adequate supportive therapythe prognosis is good. Leptospirosis should b considered inthe differential diagnosis of pulmonary haemorrhage.     

Esophageal prosthesis and its most common complications

Plastic prostheses of our own modification introduced under endoscopic control, have been successfully used in 46 patients with advanced malignant or scarred stenosis of the esophagus. Despite maximum care, their introduction is associated with a certain risk of complications and incidents. In our series, the introduction of a prosthesis was complicated by perforation of the canceromatous esophageal wall in 2 patients (0.5%), and by an esophagobronchial fistula observed 12 days post-operatively in 1 patient (0,25%). To preclude fatal mediastinal complications following perforation of the esophagus by the prosthesis, X-ray examination of its patency employing water-soluble contrast media in the early stages after surgery is recommended even before peroral nutrition is resumed.     

Toxic shock syndrome and its potential complications

Toxic shock syndrome is a potentially lethal disease since the infective process established in the body can lead to multisystem involvement. The critical care nurse's understanding of this pathologic process and its potential complications will help in prevention, early diagnosis and treatment.