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By Z. Hatlod. Frostburg State University. 2019.

In addition greater care has been taken to ensure optimal translation to the underlying health concepts cheap forzest online erectile dysfunction urinary tract infection. All the survey instruments were to be validated for European use and available in a repository of common instruments effective forzest 20mg erectile dysfunction disorder. Further political demands about the quality of life of populations will come in the near future and policy makers will have more experience and higher expectations of such indicators forzest 20 mg on line erectile dysfunction due to diabetes icd 9. To be ready to meet these, the scientific community should work on second generation summary measures: true period indicators (using incidence in place of prevalence), less subjective (using measured in place of self-reported morbidity and disability and covering the whole population (rather than excluding those living in institutions such as long-term care establishments). World Health Organization (1997) The World Health Report 1997: Conquering suffering, Enriching humanity. These views have not been adopted or in any way approved by the Commission and do not necessarily represent the view of the Commission or the Directorate General for Health and Consumer Protection. The European Commission does not guarantee the accuracy of the data included in this study, nor does it accept responsibility for any use made thereof. Enquiries concerning reproduction outside those terms should be sent to the publishers. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by con- sulting other pharmaceutical literature. Six years have passed since the last edition but even in this relatively short time there have been signicant advances in the diagnosis and management of eye disease and an update has become necessary. Each author has taken a block of chapters for revision and, where needed, illustrations have been added or removed. Apart from the four main authors, I am indebted to Mr Roland Ling for his invaluable work on the chapter on the retina and once again to Professor Rubinstein for his help with the chapter on contact lenses. It remains as a textbook for medical students and those starting a career in ophthalmology, but also for those in primary care who are likely to deal with eye problems, including nurses, optometrists and general practitioners. It has been the intention to keep explanations as simple and nontechnical as possible without losing scientic accuracy; more detailed accounts should be sought in the larger textbooks. An internet version of this edition is being planned and, in order to keep down the retail price, some nancial help is needed. For this we are grateful for the interest of Pzer Ltd, whose policy of educational support has allowed this edition to go forward at its present low price. Acknowledgements Although it is now many years since the rst edition appeared, I still owe a great debt to my former secretary, Mrs A. In this new edition,I have kept Geoffrey Lyth s original cartoons,which will perhaps lighten the heaviness of the text for those with an artistic bent. The two new authors have revised a number of chapters and their fresh input to an ageing textbook has been essential and much appreciated. Finally,I would like to acknowledge the help and encouragement from Melissa Morton of Springer-Verlag, who has kept the ball bouncing back into my court with great efciency and thereby played an important part in ensuring the birth of this new edition. The need for the primary care practitioner to be well informed about common eye conditions is even more important today than when the rst edition was produced. A recent survey from North London has shown that 30% of a sample of the population aged 65 and over are visually impaired in both eyes and a large proportion of those with treatable eye conditions were not in touch with eye serv- ices. It is clear that better strategies for managing problems of eyesight need to be set up. One obvious strategy is the improved education of those conducting primary care and it is hoped that this book will contribute to this. For this second edition, I am grate- ful for the help of my coauthor Winfried Amoaku, whose personal experience in teach- ing medical students here in Nottingham has been invaluable. His expertise in the management of macular disease,now a major cause of sensory deprivation in the elderly, is also evident in these chapters. The format of the book has not changed but some of the chapters have been expanded. Cataract surgery has changed a great deal in this short time and is becoming one of the commonest major surgical procedures to be performed in a hospital. The management of glaucoma has also changed with the introduction of a range of new med- ications. Our aim has been to keep the original problem-oriented layout and to keep it as a book to read rather than a book to look at. There are a number of good atlases on eye disease and some of these are mentioned in the section at the end on further reading. Although the title of the book is Common Eye Diseases, some less common conditions are mentioned and it is hoped that the reader will gain some overall impression of the incidence of different eye diseases. The would seem to provide an ideal anatomical and problem is that of sensory deprivation owing to functional basis for specialisation, ophthalmol- degenerative disease. Degenerative changes in ogy can no longer regard itself as a specialty on the eye are now a major cause of blindness and its own but more the heading for a group of sub- although support services are being developed specialties. Over the past 100 number of journals, conferences and meetings years the science has advanced at an unbeliev- that now exist, possibly more than in any other able rate and with the increase in our knowledge specialty. There are several hundred ophthal- has come the development of treatments and mological journals all contributing to the cures, which have had a great impact on our scientic literature on the subject and many are everyday lives. As an organ of clinical specialisation, sometimes underrated, but a consideration of the eye does have a special advantage; it can the part played by vision in our consciousness be seen. So much little careful consideration of the meaning of are the component parts of the eye on display blindness, it is easy to sense the rational and to the clinician that when a patient presents irrational fears that our patients present to us in to a casualty department with symptoms, the the clinic. Nevertheless, in a modern European explanation of the symptoms should be made community the effects of blindness are not so evident by careful examination. Compare this apparent as in former years, and blind people with the vague aches and pains that present tapping their way about the street or begging to the gastroenterologist or the neurologist, for food are less in evidence to remind us of the symptoms that might ultimately resolve with- deprivation that they suffer. The effective application of preventive medicine and student or newly qualied doctor must be the efcacy of modern surgical techniques. Several blinding conditions limited necessarily centred on the globe of the eye it- to the eye itself, such as glaucoma and macula self, and there are a number of conditions that degeneration, were also described at this time. In the eighteenth century,con- a surgical specialty but it provides a bridge siderable advances had been made in the tech- between surgery and medicine. Most of the nique and instrumentation of cataract surgery, surgery is performed under the microscope and and the science of optics was being developed here the application of engineering principles in to enable the better correction of refractive the design of ner and ner instruments has errors in the eye. There is overlap with teenth century, the existing ophthalmological the elds of the plastic surgeons and the neuro- services were denitely limited, as is revealed in surgeons. On the medical side, the ophthal- the writings of the famous diarist, Samuel mologist has links with the physicians and Pepys. Although we have no record of his eye particularly the diabetic specialists and condition other than his own, he did consult an cardiologists, not to mention paediatricians oculist at the time and unfortunately received and dermatologists. His failing eyesight brought his diary to an abrupt end in spite of the use of special glasses and the Historical Background medicaments, which caused him great pain.

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Large focal or diffuse tumors may completely nial thoracic lesions are possible such that tetraparesis involve the uterus or the entire caudal reproductive may be observed purchase forzest 20mg on line erectile dysfunction treatment chennai. Reproductive tract neoplasms are much easier to again be focal discount 20 mg forzest amex erectile dysfunction treatment in lahore, multifocal forzest 20mg free shipping erectile dysfunction age 55, or diffuse. Lymphosarcoma of identify in nongravid tracts than in heavily pregnant the brain also has been observed but is much less com- cows, in which placentomes and the fetus frequently mon than spinal cord compressive neoplasms and is obscure the masses. Although not a rm rule, compres- uncover reproductive tract lymphosarcoma before de- sive lymphosarcoma neoplasms affecting the spinal cord velopment of overt systemic signs, but palpable uterine frequently cause neurologic signs before the patient s masses discovered per rectum must rst be differenti- ated from other uterine tumors, as well as uterine and periuterine abscesses and hematomas. Focal, mul- tifocal, or diffuse neoplasia is possible, thereby explain- ing the plethora of potential clinical consequences. Lymphosarcoma in the left retrobulbar region causing Respiratory signs associated with lymphosarcoma pathologic exophthalmos and exposure damage to the masses include inspiratory stridor resulting from nasal globe. Diffuse splenic lymphosarcoma with lymphosarcoma masses compressing the spinal may result in splenic capsular rupture, subsequent fatal cord usually progress from paresis to paralysis within 2 intraabdominal hemorrhage, and acute death. During this time, they may be noticed to have sion is observed as the cause of fatal exsanguination difculty rising, require manual assistance (lifting them approximately once yearly by the Necropsy Service at by the tail) to rise, or make repeated attempts before be- the Cornell University Veterinary College. Loss of tail hemorrhage causing acute death is not rare in adult and anal tone and perineal desensitization may also be dairy cattle; most have no proven etiology; and only a seen with caudal lymphosarcoma lesions involving the few are caused by lymphosarcoma. Symptom- Lymphosarcoma masses are possible in virtually atic treatment with corticosteroids may result in tempo- any tissue, and cattle with lymphosarcoma tumors in rary clinical improvement. Diffuse lymphosarcoma in weeks to a few months, and almost all succumb one or both ureters may cause hydronephrosis, hematu- within 6 months. Extradural spinal cord compressive neoplasms af- liatively in terms of reaching parturition. However, the fecting sacral segments also may cause bladder dysfunc- prognosis beyond palliative treatment for more than a tion. It is possible to see some suc- colic, renal azotemia (bilateral), hematuria, or other cess with the use of nonabortifacient corticosteroids signs. Tumors affecting the urinary system frequently in late pregnancy, typically prednisone (1 mg/kg daily) are palpable on rectal or vaginal examinations. Enlarge- or isoupredone acetate in the treatment of cattle ment of the left kidney may be appreciated on routine with retrobulbar, thoracic, or abdominal visceral tu- rectal examination, and this should prompt ultrasono- mors. It should be remembered that dexamethasone graphic evaluation of both kidneys transrectally and/or is highly unlikely to cause abortion in the rst transabdominally. Signicant differentials for renal 150 days of gestation, so this may be an option for lymphosarcoma include other nonpainful, rm masses open cows with lymphosarcoma, for which the only such as those encountered with renal carcinomas and goal is to retrieve embryos for preservation of genetic renal amyloidosis. Denitive diagnosis phosarcoma that are limped through to parturition may be reached by biopsy. These calves are also commonly mary gland or mammary lymph nodes may be occult or infected in utero and bull calves would therefore be of overt. Such calves have high perinatal mortality clinically affected than the mammary glands, and rates and can be challenging to save. Diffuse inltration or focal lymphosarcoma such as vincristine, L-asparaginase, and cyclophospha- tumors are possible in one or more mammary glands mide in the treatment of individual cows with lym- and are best detected by palpation of the glands. Such tumors are rm and either nodular or ited in animals whose milk or meat is intended for plaquelike. Skin tumors are usually 5 to 20 cm in diam- human consumption, and the use of such large doses eter. Palliative treatment of most apparent in the region of the paralumbar fossa, is a late pregnant cow with pericardial lymphosarcoma rarely associated with lymphosarcoma in dairy cattle. Tumor cells pression, pleural effusion, and pulmonary edema contrib- of sporadic lymphomas represent immature lineages of T ute to signs of dyspnea. The protooncogene c-Myb is within the thorax or thoracic inlet also may cause jugular expressed in most sporadic lymphomas but not enzootic vein distention as a result of reduced venous return and lymphomas. Younger racic mass may be suspected based on mufed heart cattle are generally affected by the B-cell calf form. The sounds or reduced air sounds in the ventral hemithorax most obvious clinical sign with either form is diffuse unilaterally or bilaterally. Fever is a common sign, but the lymphadenopathy that results in obvious and palpable exact mechanism of fever is poorly understood. Palpation of cervical masses resulting from with juvenile/calf lymphosarcoma, and bone marrow le- thymic lymphosarcoma can be misleading because the sions and peripheral leukemia are common in the 4- to masses may feel soft, uctuant, or edematous in some 7-month-old calves. Cervical seems to have a higher incidence of juvenile/calf lympho- enlargements may be so soft, edematous, or uctuant as sarcoma than the other dairy breeds. Progressive enlargement of the or biopsies will conrm the lesions as lymphosarcoma. Most patients, however, develop a been described in calves 4 to 10 months of age in France caudal cervical swelling, which may progress in a cranial during 1987 and 1988. Genetic implications have not been described in the United States, possibly because of a lack of cases. Lymphadenopa- thy may accompany the skin lesions or appear later in the course of the disease. Although cattle with skin lymphosarcoma appear otherwise healthy during the early phase of the disease, their body condition and health deteriorate over 6 to 12 months, and eventually those cattle succumb to dif- fuse neoplasia. Insect bites may cause supercial der- Newborn heifer calf with juvenile multicentric lympho- matitis or bleeding from the skin nodules, and some sarcoma. The heifer was one of a pair of twins both nodules are present in this form of the disease and al- of whom were born with sporadic lymphosarcoma. Pooled serum envelope glycoprotein and probably assists viral bind- samples from groups or herds may be surveyed by the ing to host cells. Although this lag time between infection appear almost always to have such antigens. The best aids are cytology or positive dams and infection in those young animals biopsy collected from effusions or target organs. False-negative ndings usually result from be helpful when large tumors are suspected in these failure to detect antibodies during early infection, usu- body cavities. Lymph node aspirates or biopsies time of parturition as maternal antibodies, in effect, conrm a diagnosis of lymphosarcoma in some patients drain into the udder. Pelvic or reproductive tract masses may be aspi- may be superovulated and their embryos placed in sero- rated or biopsied through the vagina in some cattle to negative heifers or cows. If visceral masses within body cavities, the retrobulbar serologic tests are used in this control program, limita- space, or the heart. Early infections Forestomach neoplasia, abomasal neoplasia, and may yield false-negative results as may some periparturi- other visceral involvement may require laparotomy to ent cows. Therefore repeat testing of the entire herd is conrm diagnosis when other ancillary tests have failed required in 3 to 6 months. New York compressive spinal neoplasms or abomasal inltration and some other states have also sponsored programs to occurs. Segregation acid dehydrogenase values also may be elevated in some must be enforced, and facilities such as milking areas cattle with lymphosarcoma, but this nding is not spe- must be separate.

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Maternal deaths and substandard care: the results of a confidential survey in France cheap 20 mg forzest overnight delivery xyzal impotence. Epidmiologie de la mortalit maternelle en France order forzest 20mg mastercard erectile dysfunction drugs singapore, de 1996 2002 : frquence discount 20 mg forzest mastercard erectile dysfunction at age 24, facteurs et causes. Substandard care in immigrant versus indigenous maternal deaths in The Netherlands. Trends in cerebral palsy among infants of very low birthweight (<1500 g) or born prematurely (<32 weeks) in 16 European centres: a database study. Self-reported quality of life of 8-12-year-old children with cerebral palsy: a cross- sectional European study. Differences in management and results in term-delivery in nine European referral hospitals: descriptive study. Long-term consequences on postnatal well-being and neurosensorial development in terms of disabilities and quality of life will also be discussed. Moreover, the long-term consequences of extreme prematurity are considerable in terms of compromise of their well-being as children and adults3, causing stress for families4 and economic burden for health systems5. Furthermore, most disabilities of perinatal origin are more frequent in premature than in term infants. One possible cause is the increased number of twin pregnancies, related to increasing maternal age and accessibility to assisted reproduction techniques8. Neonatal mortality reporting systems from civil and birth registers are well established but have traditionally included weight-specific data only for the whole category of Low-Birth- Weight (i. Years ago data from more immature infants was often under-reported because at those low gestational ages and weights mortality was extremely high. In the last few decades, improvements in perinatal and neonatal care have pushed back the limits of viability, so collecting data from those immature infants has become extremely important. This project collects aggregated perinatal data (maternal morbidity and mortality and neonatal mortality), but not data on short-term morbidity and long-term disability outcomes for these very high risk infants. In the medical field, networking has been used to improve the quality of health care provided to patients by means of disseminating information. Existing neonatal networks collect standardised patient data to promote excellence in clinical practice by use of benchmarking and comparisons of outcomes, to promote research, continued education and quality improvement projects. Periodic reports are generated with standardised comparisons of selected outcomes used by participating units to identify opportunities for improving care processes and evaluating effects of improvement efforts. The 24- months follow-up set of indicators to assess health and neurodevelopment status can be considered temporary. To evaluate health programs and develop priorities for planning, promotion and evaluation of short- and long- term care of these infants by health organisations. To document clinical variability of the care process and its outcomes with the aim of developing the optimal application of health care. To push forward consensus in health policies and strategies to improve care of these high-risk premature infants. Morbidity and mortality data from the 2006 EuroNeoStat cohort of immature infants will be used in this report, emphasising the influence of gestational age, birthweight and gender. Table V shows the infant characteristics of the cohort that had a mean birthweight and gestational age of 1152 g and 28. The most important protective factor was prenatal corticosteroid use, being given to 81. The reasons for this are unclear, but imminent delivery is likely to be a major contributing factor. A broader approach to health measurement in follow-up studies should include both long-term objective disability assessed by third-party34,35 and subjective self-reported quality of life36, since neonatal interventions which appear to have minimal effect on mortality and neurodevelopment at an early age may profoundly influence the quality of life in later childhood and adult age37. Even though published follow-up studies did not use comparable outcome measures, developmental disabilities resulting from cognitive, motor or sensorial impairments were more likely at lower gestational age. Overall, severe disability might be present in 20% of children born under 29 weeks and when assessed at 24-30 months it was a strong predictor of moderate-severe disability at school age34. Babies who died in the delivery suite represented 3% of all babies born and 20% of all neonatal deaths. With this methodology, outcome variability and possible inequalities can be detected allowing units to perform their own benchmarking to discover areas with opportunities to improve the care process and to measure effectiveness of quality improvement initiatives implemented. The range is greater for the more immature and smaller infants and decreases as gestational age and birthweight increases. It is noteworthy that a wide range was observed among EuroNeoStat units in C-section rates (Fig. Regarding the assessment of quality of care, as measured by the degree of use of evidence- based effective interventions indicates two units had unusually low rates of prenatal steroid use (Fig. Variability of the rates of surfactant administration at any time () and during the first hour of life (X) (C). However, no specific data have been reported so far for these immature newborn infants. Outcomes that could be explored for patient safety are based on the wide variability of rates of nosocomial infection among EuroNeoStat units (0 to 41. The EuroNeoStat project includes the EuroNeoSafe initiative with a mission is to develop a culture that places the safety for these tiny patients first, by minimising medication errors and other mistakes which might have a significant impact on neonatal morbidity and mortality. The purpose of this tool is not to find the guilty party, as to err is human, but to help units to analyse and clarify the causes of incidents and to learn from them to put forward corrective mechanisms to reduce the frequency and consequences of this kind of error. Its also has long-term consequences on childhood well-being, family stress and prolonged need for health resources. Prevention of very premature delivery, although much sought after, has been elusive. In this context, prenatal pharmacological induction of fetal maturity by prenatal steroids is an effective and efficient intervention. Ready access to intensive care for these high risk infants is mandatory to improve their short and long-term outcomes. Nevertheless, the network is growing fast and so is the number of cases being collected. This weight-specific mortality rates account for about three quarters of the mortality variance observed among countries and regions. Self-perceived health, functioning and well-being of very low birth weight infants at age 20 years. Parental experiences during the first period at the neonatal unit after two developmental care interventions. European indicators of health care during pregnancy, delivery and the postpartum period. Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies. Improved outcome of outborn preterm infants if admitted to perinatal centers versus freestanding pediatric hospitals. A European Information System on the Outcomes of care for Very-Low- Birth-Weight Infants. Prenatal predictors of mortality in very preterm infants cared for in the Australian and New Zealand Neonatal Network.

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Complete may be documented in some cattle with pneumothorax drainage is the key to successful treatment buy forzest without prescription statistics for erectile dysfunction. Irritat- increased bronchovesicular sounds in the ventral lung ing solutions such as iodine products are contraindicated generic 20mg forzest mastercard erectile dysfunction pump in india, elds and absence of lung sounds dorsally purchase forzest 20mg on-line erectile dysfunction causes medscape. Severe exertion during parturition, exertion during long-term antibiotic therapy and complete evacuation/ restraint for treatment or surgery, penetrating thoracic drainage. Therefore the affected cow must be of substan- wounds, or pharyngeal/laryngeal injury causing a pneu- tial value to justify the medical expenses and associated momediastinum that ruptures into the chest may cause loss of milk sales for several weeks. Ultrasonography diaphragm may result either in frank pleuritis with may be helpful in diagnosing the pneumothorax (there pleural uid accumulation, thoracic abscess, or dia- is no normal sliding of the dorsal air line) and determin- phragmatic hernia. Pneumothorax must be differentiated from uid pleuritis that is not encapsulated results, the af- bullous emphysema and pulmonary edema. Radio- fected cow has an acute disease with large amounts of graphs or ultrasonography will conrm the diagnosis septic pleural uid free in the pleural space. If history, auscultation, and Surprisingly few cattle with bacterial bronchopneu- percussion suggest the diagnosis, thoracic puncture and monia develop clinically signicant pleural uid accu- vacuum evacuation of free air should be attempted mulation. Nonetheless, pneumonia remains the most through the dorsal ninth or tenth intercostal space. Diagno- presence of free air conrms the diagnosis, and airway sis of pleural uid accumulation unilaterally or bilater- sounds should return to the dorsal thorax following ally in a cow affected with severe pneumonia dictates evacuation of free air. Pleural effusion associated with ogy and culture may be necessary to assess lower airway bronchopneumonia will result in fever unresponsive to infection or inammation. Therapy requires evacuation of air from by daily thoracocentesis or continuous drainage until the affected hemithorax and treatment of any primary negligible quantities of pleural uid are obtained. Ap- problem such as pneumonia, puncture wounds, and propriate systemic antibiotics should be selected based so forth. Cattle with pneumothorax resulting from on culture and susceptibility results and maintained for bacterial pneumonia have a guarded prognosis. The clini- Pneumothorax cian must remember that, except in exogenous punc- Etiology and Signs. Dyspnea accompanied by in- ture of the thorax, pneumothorax originates from creased respiratory rate and effort coupled with absence damaged pulmonary tissue that has leaked air. Sim- of bronchovesicular sounds in the dorsal lung elds ple evacuation of the free air in the thorax will improve unilaterally or bilaterally characterizes pneumothorax the affected animal temporarily but does not guaran- or bullous emphysema. Some adult cattle appear very painful with structed to watch the patient carefully for recurrence of pneumothorax. When severe dyspnea is present, open dyspnea if the damaged lung continues to leak. Peek in cattle that requires hos- tions have confused the issue by using different syn- pitalization and connement. Fortunately, as a collected group of respiratory prob- Pneumomediastinum lems, these diseases are uncommon and much less im- Etiology and Signs. Pneumomediastinum most of- portant than infectious causes of respiratory diseases in ten accompanies severe pulmonary parenchymal diseases dairy cattle. Therefore they will be described individually that result in emphysema and bullae formation. Several ize that the nomenclature of these diseases has changed of the causes of pneumothorax mentioned previously are in the past and is likely to change in the future. In some cases there is old pulmonary pathology predispos- Acute Bovine Pulmonary Edema ing to the pneumomediastinum, whereas other cases may and Emphysema (Atypical Interstitial simply result from the exertion of calving. Signs may be Pneumonia, Fog Fever) mild or impossible to separate from those caused by the Etiology and Signs. Mild dyspnea, subcutane- velops within 2 weeks of the time cattle are moved to ous emphysema, and bilateral mufed heart sounds are lush pasture. The subcutaneous emphysema Perilla mint and moldy sweet potatoes may cause identi- is mostly on the dorsum of the cow as the air migrates cal syndromes. Although not as well documented, we along the aorta and through the lumbar fascial planes. It have seen similar clinical and pathological outbreaks can also be felt rectally along the aorta. Subcutaneous emphysema in a post- fected cattle develop acute, severe respiratory distress partum cow is highly suggestive of pneumomediastinum. Temperatures are normal to slightly elevated un- differentiation is aided by obvious pulmonary pathology less environmental temperatures are very high. If physical examination ndings cannot denitely acetic acid is followed by decarboxylation to 3-methylin- differentiate these problems, ultrasonography and radio- dole, which is the toxic metabolite of tryptophan. Pericardiocentesis is not indicated as lowing absorption of 3-methylindole into the systemic an initial procedure because it may subject the patient to circulation from the rumen, the mixed function oxidase unnecessary risks. Thoracic radiographs demonstrate a system metabolizes the chemical producing pneumotox- very clear cardiac and aortic shadow because surrounding icity in Clara cells and type 1 pneumocytes. Calves sel- num is not required unless the cow has labored breath- dom are affected, but adult animals over 2 years of age in ing and a probable pneumothorax. Profound dyspnea, reluctance to move, aus- Acute respiratory distress in cattle may occur with a va- cultable evidence of interstitial pneumonia (rhonchi riety of noninfectious pathologic changes. Some causes and rales) in the ventral lung eld, and quiet lungs dor- have well-documented pathophysiology, whereas others sally secondary to emphysema and edema characterize are more poorly dened and controversial. Subcutaneous emphysema may be ob- varies tremendously among pathologists and clinicians, served. Morbidity may approach 50%, and mortality resulting in much confusion regarding these disorders. Animals that are fected cow has severe lower airway dyspnea, the lungs rested, removed from the pasture, and not severely af- are very quiet on auscultation. These drugs inhibit the me- has similarities to silo ller s disease caused by nitrogen tabolism of tryptophan to 3-methylindole. However, calves and adult cattle that develop proliferative pneumonia frequently have not Proliferative Pneumonia been exposed to silo gas or other environmental nitro- Etiology and Signs. Once again, the 4-ipomeanol is pneumotoxic to these lungs reveals obliteration of alveolar space by pro- Clara cells and alveolar epithelial cells after metabolic liferating type 2 pneumocytes and interstitial edema. Unfortunately affected cattle show signs com- The question remains are all of these individual tox- mon to many diseases characterized by acute respiratory icities completely separate entities in cattle? It seems that the disease known as proliferative pneumonia may be a composite of these toxicities or may be caused by a yet- to-be-determined toxin common to the environment of dairy cattle. Another form of pathologically conrmed proliferative pneumonia has been observed in dairy calves following previous infection with and recovery from Pasteurella or Mannheimia pneumonia. The disease occurs in a single animal among a group of calves affected by Pasteurella or Mannheimia pneumonia 2 to 4 weeks previously that had seemingly recovered. Holstein with acute severe dyspnea and open mouth The degree of respiratory effort makes it impossible to breathing because of proliferative pneumonia. Affected cattle should be moved only when their ventilation and environment need to be improved. Dexamethasone (10 to 20 mg once daily) for 3 days unless the affected cow is pregnant. Broad-spectrum antibiotics for 5 to 7 days to protect against secondary bacterial pneumonia.