By U. Redge. New Mexico State University.
These findings suggested that aqueous extract of Tha-bye possessed significant hypoglycemic effect in adrenaline-induced hyperglycemic albino rat model buy 100mg doxycycline with visa. The purpose of present study was to evaluate scientifically the hypoglycemic activity of Zingiber officinale Roscoe proven 200 mg doxycycline. In this study cheap doxycycline 100mg with amex, aqueous extraction purchase 100 mg doxycycline otc, ethanolic extraction, acute toxicity, pharmacological screening test, analysis of phytochemical constituents and hypoglycemic effect of aqueous and ethanolic extract of Gin were carried out. Six adrenaline-induced hyperglycemic albino rats were used to study the hypoglycemic activity. In acute toxicity study in mice, it was observed that aqueous extract of ginger was not toxic up to the maximal feasible dose of (16g/kg) body weight. General pharmacology screening test of aqueous and ethanolic extract of ginger showed no abnormal changes. Phytochemical analysis of ginger showed that they have alkaloid, triterpene, tannin, resin, glycoside, polyphenol, carbohydrate, amino acids and reducing sugar. In observation, though aqueous extract of ginger showed no significant hypoglycaemic effect, ethanolic extract showed significant hypoglycaemic effect at the dose of 3g/kg at 1hr (p<0. These findings suggested that ethanolic extract of rhizome of ginger possessed significant hypoglycemic effect in adrenaline-induced hyperglycemic albino rat model. Khine Khine Lwin; Sandar Aung; Mu Mu Sein Myint; Aye Than; May Aye Than; Khin Tar Yar Myint; Win Win Maw; Myint Myint Khine; San San Myint. This study was carried out to determine the phytochemical constituents, acute toxicity and hypoglycaemic effect of dried leaves of Azadirachta indica A. Seven adrenaline-induced hyperglycaemic rabbits were used to study the hypoglycaemic effect. In this study, phytochemical studies of crude powder and 70% ethanolic extract of dried leaves of Azadirachto indica A. Juss showed that both contained alkaloid, steroid, flaonoid, saponin, amino acid, resin, tannin, phenol and glycoside. In acute toxicity study in mice, it was observed that crude powder of this plant, was not toxic up to the maximal feasible dose of (4g/kg) body weight. Juss at the dose level of (1g/kg) had significant hypoglycaemic effect at 3hr (p<0. In the comparison between hypoglycaemic effects of 70% ethanolic extract of dried leaces of Azadirachta indica A. Juss (1g/kg) and standard drug glibenclamide (4mg/kg), it was found that hypoglycaemic effects of both were the same. The purpose of the present study is to evaluate scientifically the hypoglycemic effect of fruits of Coccinia india (ivy gourd) (Kin-pon-thee) by using adrenaline induced hyperglycemic rat model. Fresh juice up to maximum feasible dose of 40ml/kg did not show any hypoglycemic activity. However, watery extract of 2g/kg showed hypoglycemic activity significantly at 2hour (p<0. In comparison between hypoglycemic effects of watery extract of fruits of Coccinia indica (2g/kg) and standard drug glibenclamide (4mg/kg) (negative control). It was found that both showed hypoglycemic activities but percent inhibition of glibenclamide was superior to watery extract. Pectin of different doses (1g/kg, 2g/kg, and 3g/kg) were tested on adrenaline induced hyperglycemic rats and compared with standard drug glibenclamide (4mg/kg) (negative control). Although glibenclamide had late onset of action than pectin at 1hour, the efficacy was superior to pectin in later hours. Acute toxicity studies of the fresh juice and watery extract were performed by using the albino mice. The phytochemical analysis of fresh juice of fruits of Coccinia indica had shown to have alkaloid, saponins, tanninoids, resin, and glycosides, reducing sugar, phenols, carbohydrates and triterpene. The phytochemical analysis of watery extract of fruit of Coccinia indica also showed the present of alkaloid, tanninoids, and resin, glycosides, reducing sugar, phenols, carbohydrate and triterpene. Khine Khine Lwin; Mu Mu Sein Myint; May Aye Than; Khin Tar Yar Myint; Win Win Maw; San San Myint; Myint Myint Khine; Nu Nu Win; Hla Phyo Lin. This study was carried out of determine the phytochemical constituents, acute toxicity and hypoglycemic effect of crude power and 80% ethanolic extract of dried rhizomes of Curcuma comosa Roxb. Adrenaline- induced hypoglycemic rabbits were used to study the hypoglycemic effect. The hypoglycemical studies of the crude powder and 80% ethanolic extract of this plant showed that both contained alkaloids, flavonoids, glycosides, steroids, saponins, tannins and amino acid. In acute toxicity study in mice, it was observed that the crude powder of the rhizomes was not toxic up to the maximal feasible dose of 5g/kg. The results showed that the 80% ethanolic extract of the rhizomes at the dose level of 1. But, the crude powder of the rhizomes at the dose level of 3g/kg showed no significant hypoglycemic effect. It was observed that the hypoglycemic effect of 80% ethanolic extract was inferior to that of the standard drug glibenclamide. Therefore, it can be concluded that the 80% ethanolic extrace of the dried rhizomes of Curcuma comosa Roxb. The aim of this study is to determine phytochemical constituents, acute toxicity and the hypoglycaemic effect of Andrographis paniculata Nees. Qualitative tests of the chemical constituents present in the ethanolic extract were conducted. Saponin, tannin, amino acid, carbohydrate, reducing sugar, glycosides, alkaloid and steroid were present in the ethanolic extract. The ethanolic extract was not toxic up to the maximum feasible dose level of 24g/kg body weight. The hypoglycaemic effect of ethanolic extract (3g/kg body weight) was carried out on adrenaline-induced hyperglycemic rabbit’s model. It was found that the ethanolic extract (3g/kg body weight doses) showed significant lowering the blood glucose levels at 3hr and 4 hr respectively (p< 0. It was found that glibenclamide significantly lowered the blood glucose levels at 2hr, 3hr and 4hr (p<0. Comparison between ethanolic extract and glibenclamide were not significantly different. The purpose of present study was to evaluate scientifically the hypoglycemic activity of Ficus benghalensis Linn. In this study, extraction, acute toxicity, pharmacological screening test, phytochemical constituent’s analysis and hypoglycemic effect of ethanolic extract of bark of Pyi-nyaung were carried out. The hypoglycemic activity of ethanolic extract of bark of Pyi-nyaung was done on six adrenaline-induced hyperglycemic albino rats in this study, design was done. In acute toxicity study, it was observed that ethanolic extract of bark of Pyi-nyaung was not toxic up to the maximal feasible dose of (8g/kg) body weight in mice. General pharmacology screening test of ethanolic extract of bark of Pyi-nyaung had shown no abnormal changes. Phytochemical analysis of bark of Pyi-nyaung showed the presence of alkaloid, triterpene, tannin, resin, glycoside, polyphenol, carbohydrate, amino acids and reducing sugar. The comparison between hypoglycemic effects of ethanolic extract of bark of Pyi-nyaung and standard drug, glibenclamide (4mg/kg), showed that they have similar hypoglycemic effect. Thus, it was concluded that ethanolic extract of bark of Pyi- nyaung possessed significant hypoglycemic effect in adrenaline-induced hyperglycemic albino rat model. Hypoglycemic effect of Hydrocotyle umbellata on adrenaline-induced hyperglycemic rat model. May Aye Than; Mu Mu Sein Myint; Win Win Maw; Myint Myint Khine; Aung Aung Maw; Nu Nu Win; Ei Ei Soe; Thaw Zin. Hydrocotyle umbellata (wdkif0rf-rif;cGm) had been introduced in Myanmar a few years ago. Therefore, the aim of this study was to evaluate acute toxicity, phytochemical constituents and hypoglycemic activity of whole plant of H. Flavonoid, glycoside, polyphennol, steroid/trepene, carbohydrate, reducing sugar and saponin were detected in crude powder. The crossover experimental study design was done on the adrenaline-induced hyperglycemic rat model. It was found that glibenclamide did not significantly differ from 6g/kg of aqueous extract in percentage inhibition. Therefore this finding is the first report of the hypoglycemic activity providing a potential resource for the develolpment of new phytomedicine for diabetes.
Although the combination of an opioid and an alpha-2-adrenergic agonist may act synergistically for the analgesic response buy doxycycline 200 mg without prescription, there are conÀicting results regarding this drug combination on respiratory de- pression [29 generic doxycycline 200 mg without a prescription, 30] generic doxycycline 100mg visa. In the kidney order 200mg doxycycline amex, 24 Of-label Drugs in Perioperative Medicine: Clonidine 281 alpha-2-adrenoceptor agonists promotes diuresis, increases the release of atrial natriuretic factor and decreases secretion of rennin and vasopressin . Clonidine clinically insig- ni¿cantly inhibits insulin release and decreases salivary and gastric secretions [32, 33]. Sedation-associated alpha-2 agonists seems to act through the endogenous sleep-promoting pathways [1, 11, 12]. They evaluated the dose–response relationship for 1-h infusions of clonidine 1, 2 and 4 mcg/ kg-1 h-1 in eight healthy volunteers aged 22–30 years. Clonidine infusions resulted in signi¿cant and progressive sedation, but all study participants were easily awoken to perform tests and evaluations. Statistically signi¿cant analgesia, memory impairment and reduced performance on the digit symbol substitution test occurred during 4 mcg/ kg-1 h-1 infusions. There were no statistically signi¿cant changes in cardiorespiratory variables throughout the study. In the clinical setting, clonidine is an ef¿cient means of controling anxiety during con- scious sedation, suggesting that preoperative clonidine administration could be a useful supplement to intravenous sedation for nonsurgical procedures [38–41]. Parameters and sedation score were analysed every 5 min and at four different intervals. The clonidine group presented better mean arterial pressure and heart- rate stability and sedation ef¿cacy, whereas the control group presented a signi¿cantly higher meperidine intake. Enhanced noradrenergic activity is also a major factor in the pathophysiology of stress- induced mental disorders. Clonidine could play a useful role in treating sleep disturbance and hyperarousal in posttraumatic stress disorder, with minimal adverse effects and low ¿nancial cost [42, 43]. Furthermore, they inhibit the liberation of substance P and endorphins and activate serotoninergic neurones [2, 13, 20]. Mu-opioid receptors, which coexist with alpha-2 adrenoceptors in the spinal cord, may act in synergy with alpha-2-adrenoceptor agonists [2, 36, 44–46]. In another study, during the postoperative period after spinal fusion, patients blindly received either clonidine (5 mcg/kg-1 infused the ¿rst hour and then 0. Clonidine signi¿cantly reduces morphine delivered mainly during the ¿rst 12 h [49, 50]. As is well known, hyperalgesia is a common adverse effects after using powerful short- acting opioids . In contrast, elevated pain ratings after infusion were not reduced by ketamine but were alleviated by the alpha-2-receptor agonist clonidine. In health, the nervous system exists in a balance between inhibitory and excitatory inÀuences. This balance may be upset if neural tissue is damaged or irritated and may give rise to neuropathic pain. Such neuropathic pain does not respond consistently to opioid analgesics or non-steroidal anti-inÀammatory drugs, and it may therefore be necessary to utilise other therapeutic agents (i. The neuropathic pain is mediated by low-threshold mechanoreceptors, sympathetically dependent, and sensitive to both alpha-2-agonists and N-methyl-D-aspartate antagonists. As a consequence, clonidine may also have a potential role in treating neuropathic pain [54, 55]. Studies in animals and patients have shown that transdermal, epidural and intravenous administration of the alpha-2-adrenoceptor agonist clonidine reduces pain intensity in neuropathic pain syndromes for periods varying from some hours to 1 month [56, 57]. Despite clonidine’s use for treating neuropathic, neuralgic and deafferentiating pain, a large meta-analysis found that the bene¿cial effects of sys- tematically administered clonidine were expected only in pain states with increased sym- pathetic nervous system activity (e. Clonidine was also used to avoid the development 24 Of-label Drugs in Perioperative Medicine: Clonidine 283 of complex regional pain syndrome. Clo- nidine has been administered in neuraxial blocks to improve analgesia by increasing the duration of sensory and motor block and to decrease complications associated with a high dose of a single drug. A recent systematic review of data from 22 randomised trials (1,445 patients) testing a large variety of doses of clonidine added to intrathecal bupivacaine, mepivacaine, prilocaine or tetracaine found that clonidine 15–150 mcg prolonged in a linear, dose-dependent manner the time to two-segment regression (range of means, 14–75 min) and the time to regression to L2 (range of means, 11–128 min) . The time to ¿rst analgesic request (median 101 min, range 35–310) and of motor block was prolonged, and there were fewer episodes of intraoperative pain with clonidine, without evidence of dose responsiveness. Time to achieve complete sensory or motor block and extent of cephalic spread remained unchanged. Although neuraxial clonidine prolongs anaesthe- sia, it can cause hypotension and bradycardia [60, 62], and although it prolongs analgesia in central neuraxial blocks, its use in peripheral nerve blocks remains controversial. A systematic, qualitative review of double-blind, randomised, controlled trials (27 studies from July 1991 to October 2006 of 1,385 patients) found that 15 studies supported the use of clonidine as an adjunct to peripheral nerve blocks, whereas 12 studies failed to show any bene¿t. The authors concluded that clonidine improves analgesia and anaesthesia dura- tion when used as an adjunct to intermediate-acting local anaesthetics for some peripheral nerve blocks. Evidence is lacking for the use of clonidine as an adjunct to local anaesthet- ics for continuous catheter techniques . Partial sciatic nerve liga- tion produces axonal damage, a local inÀammatory response, and wallerian degeneration. Their results suggest that perineural clonidine acts on alpha- 2-adrenoceptors to reduce hypersensitivity in established nerve injury, most likely by an immunomodulatory mechanism, and may be effective in patients in the weeks after nerve injury. Intra- articular administration of clonidine in arthroscopic knee surgery has also been described with contradictory results [67, 68]. Clonidine has also been used as a preanaesthetic because of its anxiolytic properties without having re- spiratory depressant activity and therefore may be potentially useful during that period [15, 80–89]. Premedication with clonidine reduced the requirement for volatile agents during general anaesthesia , whereas clonidine 2. However, 5 mcg/kg-1 clonidine orally was associated with prolonged recovery from propofol/fentanyl anaesthesia [86, 87]. After oral premedication with either clonidine 3 mcg/kg-1 or placebo in patients un- dergoing vascular surgery, Morris et al. Therefore, it is possible that the reduced cardiac output of these patients resulted in altered propofol disposition so that slower infusion rates were required to achieve the same blood concentrations. Induction of anaesthesia, tracheal intubation, surgical incision and surgery under regional anaesthesia and mergence from anaesthesia are associated with dramatically increased sympathetic activity. Alpha-2-adrenoceptor agonists at appropriate doses reliably control heart rate and blood pressure in patients undergoing surgery [3, 4, 69, 75, 78, 81, 90–101], including neurosurgery [24, 70, 81, 93, 102–104]. The incidence of perioperative myocardial ischaemia was signi¿cantly reduced with clonidine. In addition, clonidine reduced the in- cidence of postoperative mortality for up to 2 years. However, these patients were dispro- portionately present in the placebo group, and the mortality difference was thus considered to be due to the presence of a subset of high-risk patients in the placebo group . The lack of widespread use of clonidine by anaesthesiologists probably reÀects [108, 109]: 1. Aantaa R, Jalonen J (2006) Perioperative use of alpha2-adrenoceptor agonists and the cardiac patient. Fletcher D, Aubrun F, Adam F et al for the Comité douleur-anesthésie locorégion- ale et le comité des référentiels de la Sfar (2008) Formalized recommendations of experts 2008. Gordh T, Jansson I, Hartvig P et al (1989) Interactions between noradrenergic and cholinergic mechanisms involved in spinal nociceptive processing. Noyer M, de Laveleye F, Vauquelin G et al (1994) Mivazerol, a novel compound with high speci¿city for alpha 2 adrenergic receptors: binding studies on different human and rat membrane preparations. Sallinen J, Haapalinna A, Viitamaa T et al (1998) Adrenergic alpha-2C-receptors modulate the acoustic startle reÀex, prepulse inhibition, and aggression in mice. Tank J, Jordan J, Diedrich A et al (2004) Clonidine improves spontaneous barore- Àex sensitivity in conscious mice through parasympathetic activation. Tibirica E, Feldman J, Mermet C et al (1991) An imidazoline-speci¿c mechanism for the hypotensive effect of clonidine: a study with yohimbine and idazoxan. Koppert W, Sittl R, Scheuber K et al (2003) Differential modulation of remifenta- nil-induced analgesia and postinfusion hyperalgesia by S-ketamine and clonidine in humans. Polarz H, Bohrer H, Martin E et al (1993) Oral clonidine premedication prevents the rise in intraocular pressure following succinylcholine administration. Bonhomme V, Maquet P, Phillips C et al (2008) The effect of clonidine infusion on 288 C. Delaunay L, Bonnet F, Liu N et al (1993) Clonidine comparably decreases the thermoregulatory thresholds for vasoconstriction and shivering in humans.
Purpose: Weekly review of new patients with central or peripheral nervous system tumors for preoperative and/or postoperative treatment planning buy cheap doxycycline 200mg line. Primary audience: Pathologists buy doxycycline 100mg otc, neurologists purchase doxycycline 200 mg with visa, neurophysiology fellows generic doxycycline 200mg line, pathology and neurology residents. Primary audience: Pathologists, neurologists, neurosurgeons, pathology, neurology, and neurosurgery residents, medical students. Purpose: Review of classic or unusual cases from current surgical specimens, including consultation cases. Primary audience: Neurosurgeons, neurologists, neuroradiologists, neuropathologists, neurosurgery and neurology residents. Scholarly Activities and Research During Rotation Research within the Division of Neuropathology is an option that residents may choose for research elective activities. Incorporation of residents into experimental neuropathological work ongoing in the Division or selection of projects in clinically related research, e. Residents will be evaluated on their demonstrated ability to provide useful consultation to the clinical service teams, medical knowledge, application of this knowledge to efficient/quality patient care, and gross and microscopic diagnostic, technical and observational skills. Residents are also evaluated on their interpersonal skills, professional attitudes, reliability, and ethics with members of the teaching faculty, peers, laboratory staff, and clinicians. They are further evaluated on their initiative in fostering quality patient care and use of the medical literature, as it relates to their assigned cases. Their timely completion of assigned interpretive reports is another component of the evaluation. Chapters 27-28, Robbins and Cotran Pathologic Basis of th Disease, 7 Edition, Elsevier Saunders, Philadelphia, 2005. Surgical Pathology of the Nervous System and its Coverings, th 4 ed, Churchill Livingstone, New York, 2002. Diagnostic Pathology of Nervous System Tumours, Churchill Livingstone, London, 2002. Tumors of the Peripheral Nervous System, Armed Forces Institute of Pathology, Washington, D. Tumors of the Pituitary Gland, Armed Forces Institute of Pathology, Washington, D. Practice Guidelines for Autopsy Pathology: Autopsy Procedures for Brain, Spinal Cord, and Neuromuscular System, Arch Pathol Lab Med 119:777–783, 1995. Residents must obtain permission from the appropriate faculty member prior to scheduling the elective. Residents must obtain permission from the appropriate faculty member prior to signing up for the elective. A one month rotation can be designed to teach research skills and allow a resident time to begin a clinically related research project that will be carried forward during the rest of the training program. A goal of the rotation is to encourage pathology residents to participate in a research project that will result in formal presentation at national meetings and publication in peer-reviewed journals. Research rotations must have a focused research project and must follow the below described process for formalizing the rotation. A longer period of research training is available as elective time for those who wish to pursue an academic career. Procedure: Listed below are the required procedures for the Research Rotation • The academic year prior to scheduling a research rotation, the resident should identify a faculty sponsor, have the faculty member sign the attached form stating that they will agree to be the mentor and agree to be responsible for the research activity during the scheduled month. The faculty sponsor must submit the progress report along with the standard evaluation of the resident to the resident education committee. He continued to improve his fund of knowledge and diagnostic skills and received positive comments on performance evaluations. Overall, his performance during the last six months of his residency was very good. He interacted very well with faculty, fellow residents and staff, and was an active mentor to junior residents. His excellent background in research allowed him to continue to be actively involved in scholarly activity including publication of five manuscripts and presentation of abstracts at five national or local meetings. Was physician subject to any disciplinary action, such as imposition of consultation requirements, suspension, or termination or probation? This Committee should consist of representative Teaching Faculty and chaired by the Program Director. From this review, an Annual Program Improvement Action Plan (last section of this form) is to be developed to improve deficit areas. All these items should be reviewed and the corresponding box checked next to the item. As a way of documenting this annually, please have all institutional site directors sign this report as well. I have discussed this report as it pertains to each Participating Institution with each Participating Institutional Site Director. Today Internet resources may not readily provide information on who is responsible for the content, and where that person or organization may be. For example, a site may provide an organization name, but have no indication of where that organization is geographically. Authors can spend hours searching for this information to include it in brackets, or choose the allowable [publisher unknown], [place unknown], etc. Perhaps it is time to rethink the necessary information to identify a cited work today, and to better standardize citations across diferent media and publication types. Authorship, titles, and dates (content created or published, revised, and cited if on the Internet) are still crucial – but what else is essential? In addition, is it possible to apply the same order xvi Citing Medicine and punctuation to all references? Print materials are still used and need consideration; however, electronic resources prevail and citing these materials needs to be simplifed. Backus / Joyce Backus Associate Director for Library Operations National Library of Medicine xvii Foreword Te Internet has fundamentally changed the publishing model that authors, editors and publishers have followed for centuries. Information that took months or years to publish, edit and distribute in print is now produced and available to the public worldwide on an accelerated schedule. Despite changes brought by technology, the need to accurately cite the source of information for scholarly publication remains. And, while the need to cite remains, the challenges of collecting and reporting accurate, lasting citation information have increased tremendously. Electronic publishing creates new issues of impermanence that paper did not present. With this publication, Citing Medicine, the National Library of Medicine strives to provide those charged with capturing an accurate scholarly citation with a guide to do so in this new era of electronic information, both permanent and ephemeral. Tese same rules and examples can be used for magazines and other types of periodicals. Journal Articles • Sample Citation and Introduction • Citation Rules with Examples • Examples B. Parts of Journal Articles • Sample Citation and Introduction • Citation Rules with Examples • Examples C. Sample Citation and Introduction to Citing Journal Articles Te general format for a reference to a journal article, including punctuation: Examples of Citations to Journal Articles 4 Citing Medicine By tradition, the rules for formatting references to journal articles permit greater abbreviation compared to books: • Journal references omit information on place of publication and publisher, whereas book references carry these details. Tis brevity in citing journal articles stems from the need to conserve space in printed bibliographies and the early databases. Following are some important points concerning citing journal articles: • Cite the journal name that was used at the time of publication. Too many variations in type styles may actually make the reference harder to read. Te source for journal title, volume, issue, and date information is, in order of preference: (1) the title page of the issue, (2) the issue cover, and (3) the masthead. Running headers or footers may not carry the ofcial title of a journal and date and issue information may be missing from these locations. Citation Rules with Examples for Journal Articles Components/elements are listed in the order they should appear in a reference. An R afer the component name means that it is required in the citation; an O afer the name means it is optional. Author (R) | Author Afliation (O) | Article Title (R) | Article Type (O) | Journal Title (R) | Edition (R) | Type of Medium (R) | Date of Publication (R) | Supplement/Part/Special Number to a Date (R) | Volume Number (R) | Supplement/Part/Special Number to a Volume (R) | Issue Number (R) | Supplement/Part/Special Number to an Issue (R) | Location (Pagination) (R) | Physical Description (O) | Language (R) | Notes (O) Journals 5 Author for Journal Articles (required) General Rules for Author • List names in the order they appear in the text • Enter surname (family or last name) frst for each author • Capitalize surnames and enter spaces within surnames as they appear in the document cited on the assumption that the author approved the form used. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Names in non-roman alphabets (Cyrillic, Greek, Arabic, Hebrew, Korean) or character-based languages (Chinese, Japanese).
This Crested Cardinal the blue remiges on the left wing doxycycline 200 mg low cost, frequently seen with nutrient oversupplementation would start singing and hop from limb to limb when approached; however 200mg doxycycline fast delivery, when and microhepatia discount 200mg doxycycline overnight delivery. Nor- from the body (“fluffed up”) buy 200 mg doxycycline, suggesting dif- mal sleeping behavior must be differenti- ficulties in maintaining normal body tem- ated from lethargy or depression (Color perature. Hypovitaminosis A glazed, sunken eye (dehydration) and par- is frequently implicated. This bird would ex- these lesions can become infected (eg, bum- hibit intermittent periods of vocalization blefoot), causing crippling or life-threaten- and wing-flapping, and would then slip ing changes. Note the hyperemia and swelling fed an all-seed diet, was overweight and of the tissues associated with the auditory had elevated liver enzymes. Note the yellowish discoloration of the urates lated diet supplemented with limited fresh fruits and vegetables and was given fre- (suggestive of liver disease) and the ab- sence of feces. Different cian should wear ear protectors to prevent hearing strains of a particular bacteria may appear morpho- loss when handling large screaming psittacine birds. Distinguishing between pathogenic and non- or slit lamp will help in discerning subtle changes pathogenic strains of the same genera of bacteria or associated with the skin, feathers, head, cloaca, oral fungi requires detailed biochemical analysis. Properly interpreting a Gram’s stain requires that An otoscope may also be useful in evaluating the oral the clinician determine if the organism detected is cavity, cloacal mucosa and pharyngeal area. A clini- physical examination process should be performed cally normal bird with an abnormal Gram’s stain quickly and efficiently. With practice, a thorough should be observed for changes that could indicate a examination can be performed on a critically ill pa- problem. It is a clinical mal Gram’s stain over a three- to six-week period is judgement to determine if something is normal for common in birds that are changed from an all-seed to the individual patient yet abnormal for the species as a formulated diet. While a physical examination can be per- formed using different regional or anatomic ap- An improperly evaluated Gram’s stain can result in proaches, the key to detecting subtle abnormalities is unnecessary antibiotic therapy that is detrimental to to consistently use the same approach (using a physi- an individual bird or to an aviary as a whole. A small bird can easily be removed from its enclosure by turning out the lights and gently removing the bird from its perch. A paper or cloth Examination of the Patient towel can be used for removing larger patients from Once a bird’s enclosure has been evaluated for clues their enclosures. Paper towels are best for handling that may indicate abnormalities and the bird has birds because they can be discarded after use. If cloth been carefully observed in its environment, it is time towels are used, they should be laundered and auto- to perform a hands-on physical examination. The claved between each bird to prevent nosocomial in- initial consideration in performing a physical exami- fections. A never be used to restrain psittacine or passerine client should be informed that handling a critically ill birds. Tame birds may associate the shape of the bird can destabilize the patient to a point where it glove with discomfort and may equate the hand with can no longer compensate. Removing the top or bottom of an enclosure The examination room used for birds should be se- may be easier than attempting to remove the bird cluded, sealable, easily cleaned, contain minimal fur- through the enclosure door. The towel can be used to niture, have dimmable lights and should not have position the bird so that it is facing the side of the ceiling fans or uncovered windows. With smaller, enclosure in order to have free access to the back of easily stressed species (eg, finches, canaries), per- its head. The best time to grab the bird is when it forming the physical examination in a dimly lighted bites the side of the enclosure. Small birds can be restrained with one hand by Any equipment or supplies that may be needed placing the bird’s head between the second and third should be prepared before a bird is removed from its fingers (Figure 8. The Dermis and its Unique Adaptations The feather condition of a bird is an excellent indication of its overall health. Ear protectors should always be available in the examination (pterylae) and non-feathered areas room and treatment area to prevent the hearing loss that can occur from repeated exposure (apteria) of the body. Genetically induced baldness has been de- able to move the sternum in order to breathe, and scribed in cockatiels. Some incubating hens will de- excessive force on the chest can result in asphyxi- velop a featherless area on the abdomen called a ation. The normal feather brilliance or “sheen” is derived The towel used to initially remove a bird from its from a combination of physical color, structural re- enclosure can remain around the bird at a level even flection of light (structural color), the presence or with the upper eyelid and just below the nares. This absence of powder from the powder down feathers (if gives the bird something to chew on, as well as present) and oil from the preen gland (if present). A large bird bird loses its sheen if abnormalities occur in any of can be cradled on its back between the clinician’s the factors that contribute to the reflectivity of the body and arm. For some clinicians, a complete physi- and evenly from one portion of the feather to another. The skin over most of a bird’s body is thin, soft, dry and relatively translucent (Figure 8. Small portions of discarded feather sheaths are normally found on the skin and should not be confused with dry, flaky skin. Examination of subcutaneous tissues can be enhanced by wetting the overlying feathers with warm water or alcohol (Figure 8. Balding, thinning, swelling, peeling or ul- cerations of the skin or scales of the feet and legs are indications of abnormalities. Chang- ing a bird from a seed-based to a formu- lated diet, supplemented with fresh fruits and vegetables, will generally cause a dra- matic difference in the skin and feather condition. The improvement in the feather quality will be most noticeable with the first molt following the diet change. When a bird is relaxed, the feathers lie flat and follow the natural con- tour of the body. The towel can be the body, and feathers from a damaged wrapped around the bird’s body to provide additional restraint. The bird can be follicle may twist or grow in an abnormal cradled in a sitting position between the clinician’s body and arm, leaving both hands free to palpate body surfaces and to manipulate the feet and wings during direction (see Color 24). Wet, sticky or stained feathers feather shaft (rachis) is smooth and gradually around the nares are indications of rhinitis. General- changes from thin at the tip to thick at the base ized feather abnormalities indicate systemic abnor- (calamus). The contour feathers One of the many functions of feathers is to retain that cover the body should blend with each other, body heat. If chilled, a bird increases its insulation giving the bird a smooth, compact appearance (Color capacity by increasing the distance between the 8. Feathers should be complete and intact feathers and the skin (fluffing up), therefore creating throughout their length and width. Some fluffing can broken or frayed feather edges are indications of a be considered normal in birds that are restricted to problem (see Color 24). A bird that is diseased may Malnutrition in general may cause these kinds of be “fluffed” because it is chilled or because it is con- feather problems. Such birds appear sparsely feath- suming insufficient energy to maintain a proper me- ered, not because the feathers are reduced in number tabolic rate and compensate for normal heat loss. These problems are often characterized by discharges from or enlargement of the feather follicles (see Color 24). Damage that occurs to a feather during development is characterized by an abnormal feather structure or color that is evident as the sheath is removed from the differentiated feather. Dark lines located transversely across sev- eral feathers (stress lines) indicate that an adreno- cortical surge occurred while the affected feather was developing. Post-developmental feather problems are characterized by an abnormal rachis, barb or barbules but a normal follicle and calamus. The fact that avian skin is translucent uneventful with an old feather being forced out by a allows direct visualization of many subcutaneous structures in- cluding vessels, the crop, tendons, ligaments, body musculature, newly developing feather (see Chapter 24). Retention of the feather sheath is not normal, and may indicate mal- nutrition, pansystemic disease or an infectious agent. Damaged pin feathers cut or broken off at the surface may be black and mistaken for mites. Head feathers may appear abnormal in canaries that are malnourished, especially in repro- ductively active hens. The powder down feathers of the prolateral region should be examined for the presence of powder for- mation or feather deformities. Moist lacerations or ulcerations may be noted in the axillary region in some birds with dermatitis (see Color 24).
The average annual cost of cranberry tablets was $624 discount 100mg doxycycline, whereas the juice cost $1 quality doxycycline 100 mg,400 generic doxycycline 100mg otc. The possible explanation again is that since cranberry proanthocyanidins do not prevent the adhesion of all types of bacteria to the urinary tract lining 100 mg doxycycline with visa, cranberry may not be effective in all cases. The bottom line is that cranberry is very safe and can be quite effective, so it is worth using. One sure beneﬁt is that cranberry ingestion can signiﬁcantly reduce strong urinary odor—a common problem in elderly people, especially those in nursing homes or assisted living facilities. It has been used by women for centuries, with the ﬁrst recorded use in the thirteenth century. It exerts urinary antiseptic activity by means of its component arbutin, which typically makes up 6. It is the hydroquinone that prevents bacterial growth, and it is most effective in an alkaline urine. The preventive effect of a standardized uva ursi extract on recurrent cystitis was evaluated in a double-blind study of 57 women. These impressive results indicate that regular use of uva ursi, like cranberry, may prevent bladder infections. Uva ursi has also been shown to be helpful in increasing the susceptibility of antibiotic-resistant bacteria to antibiotics. Goldenseal Goldenseal (Hydrastis canadensis) is one of the most effective of the herbal antimicrobial agents. Its long history of use by herbalists and naturopathic physicians for the treatment of infections is well documented in the scientiﬁc literature. Immune Support See the chapter “Immune System Support,” for a complete discussion on how to optimize the functioning of your immune system. Owing to the possibility of a kidney infection, it is imperative to consult a physician if there is fever, low back pain, nausea, or vomiting. Although the occasional acute bladder infection is easily treated, dealing with chronic cystitis can be a challenge. Long-term success requires determining the underlying cause, such as loss of the probiotic urethral shield, structural abnormalities, excessive sugar consumption, food allergies, nutritional deficiencies, or chronic vaginitis. General Recommendations • Drink large quantities of ﬂuids (at least 64 ﬂ oz per day), including at least 16 ﬂ oz unsweetened cranberry juice or 8 ﬂ oz blueberry juice per day. The symptoms must be present for at least one month to be called clinical depression. Used in this context, mood means a prolonged emotional tone that dominates an individual’s outlook. Obviously, there is a spectrum of clinical depression, ranging from mild feelings of depression to serious consideration of suicide. In order to be ofﬁcially diagnosed as dysthymic, a person must be depressed most of the time for at least two years (one year for children or adolescents) and have at least three of the following symptoms: • Low self-esteem or lack of self-confidence • Pessimism, hopelessness, or despair • Lack of interest in ordinary pleasures and activities • Withdrawal from social activities • Fatigue or lethargy • Guilt or ruminating about the past • Irritability or excessive anger • Lessened productivity • Difficulty concentrating or making decisions Approximately 20 million Americans suffer from true clinical depression each year, and more than 30 million Americans take antidepressant drugs. Although this behavior is apparent in many clinical cases, the theory has no substantial proof. This theory holds that depression is an extension or outgrowth of behaviors used to control others, such as pouting, silence, or ignoring something or someone. This theorizes that depression is the result of habitual feelings of pessimism and hopelessness. This stresses biochemical derangement characterized by imbalances of biogenic amines. In this model, the ruminative thinking processes of a person with depression facilitate complex, social problem solving. Of the various psychological theories of depression, the one that may have the most merit is the learned helplessness model, developed by Martin Seligman, Ph. His animal model provided a valuable clue to human depression, as well as serving as the research model to test antidepressant drugs. They got exactly the same shocks as the ﬁrst group but could not turn off the shock. The shock would cease only when the “yoked” dog in the ﬁrst group would press its nose to the panel. Thus the second group of dogs had no control over the degree of shock they received. Once the dogs went through this ﬁrst part of the experiment, they were placed in a “shuttle box,” a box separated in the middle by a small barrier that the dogs could jump over. The dogs would be electrically shocked but could escape the shock by simply jumping over the barrier to the other side. Seligman hypothesized that the ﬁrst and third groups would quickly ﬁgure this out but that the second group of dogs would have learned to be helpless in that they would believe nothing they could do mattered. Seligman thought that the dogs in the second group would simply lie down and accept the shock. As predicted, the ﬁrst and third groups of dogs learned within seconds that they could avoid the shock by jumping over the barrier, while the dogs in the second group would simply lie down and not even make an effort to jump over the barrier, though they could see the other side of the shuttle box. Seligman and his colleagues went on to show that many humans react in a fashion identical to that of animals in these experiments. The adoption of Seligman’s model was revolutionary in psychopharmacology, as it became an effective experiment to test antidepressant drugs. Basically, when animals that had learned to be helpless were given antidepressants, they would unlearn helplessness and start exerting control over their environment. Researchers discovered that when animals learned to be helpless, this resulted in alteration of brain monoamine content. Researchers also discovered that when animals with learned helplessness were taught how to gain control over their environment, their brain chemistry also normalized. The alteration in brain monoamine content in the animals with learned helplessness mirrors the altered monoamine content in human depression. Although most physicians look quickly to drugs to alter brain chemistry, helping patients to gain greater control over their lives actually produces even greater biochemical changes. One of the most powerful techniques to produce the necessary biochemical changes in the brains of depressed individuals is to teach them to be more optimistic. Outside the laboratory setting, Seligman discovered that the determining factor in how a person would react to uncontrollable events, either “bad” or “good,” was his or her explanatory style—the way in which the person explained events. However, individuals who were pessimistic were extremely likely to become depressed when something went wrong in their lives. Seligman and other researchers also found a direct correlation between an individual’s level of optimism and the likeliness of developing not only clinical depression but other illnesses as well. Optimists rarely got depressed, but pessimists were extremely likely to battle depression and other psychological disturbances. Serotonin has been referred to as the brain’s own mood- elevating and tranquilizing drug. Because the manufacture of serotonin in the brain is dependent upon how much tryptophan is delivered to the brain, in experimental studies researchers can feed human volunteers or animals diets lacking tryptophan and note the effects of such a diet. The results from these sorts of studies have contributed greatly in our understanding on just how vital proper levels of serotonin are to a positive human experience. For example, low levels of serotonin are linked to depression, with the lowest levels being observed in people who have committed or attempted suicide. Most of the commonly used antidepressant drugs work primarily by increasing the effects of serotonin. Once serotonin is manufactured in the brain it is stored in nerve cells waiting for release. Upon release, the serotonin carries a chemical message by binding to receptor sites on the neighboring nerve cell. Almost as soon as the serotonin is released enzymes are at work that will either break down the serotonin or work to uptake the serotonin back into the brain cells. It is at this point that various drugs typically work to either inhibit the reuptake of serotonin or prevent its breakdown. Because serotonin reuptake is inhibited, there is more serotonin hanging around, capable of binding to receptor sites. The effectiveness of antidepressant drugs has been the subject of several reviews. The results indicate that they have not been shown to work any better than a placebo in cases of mild to moderate depression, the most common reason for prescription medication, and claims that antidepressants are more effective in more severe conditions have little evidence to support them.
Balance performance on the postural stress test: comparisons of young adults purchase 100mg doxycycline mastercard, healthy elderly and fallers buy discount doxycycline 200 mg on-line. Static versus dynamic predictions of stepping following waist-pull perturbations in young and older adults discount doxycycline 200 mg otc. Postural coordination in el- derly subjects standing on a periodically moving platform purchase doxycycline 200mg on-line. An epidemiological study of falls in older com- munity dwelling woman: the Randwick falls and fracture study. Impairment of posturo-kinetic coordina- tion during initiation of forward oriented stepping movements in parkinsonian pa- tients. The effect of posture and ‘postural set’ on leg muscle responses to perturbation, and its relation to the severity of the disease. Central programming of postural movements: adaptations to altered support surface configurations. Open-loop and closed-loop postural control mechanisms in Parkinson’s disease: increased mediolateral activity during quiet standing. Effects of deep brain stimulation and levodopa on pos- tural sway in Parkinson’s disease. Comparison between subthalamic nucleus and globus pallidus internus stimulation for postural performance in Parkin- son’s disease. Impaired scaling of long latency postural reflexes in patients with Parkinson’s disease. Influence of dopaminergic medication on automatic postural responses and balance impairment in Parkinson’s disease. Effects of dopamine on postural control in parkinsonian subjects: scaling, set, and tone. Selective depression of medium-latency leg and foot muscle responses to stretch by an alpha 2-agonist in humans. Postural set for balance control is normal in Alzheimer’s but not in Parkinson’s disease. Postural adjustments associ- ated with rapid voluntary arm movements in patients with Parkinson’s disease. Anticipatory postural reflexes in Parkinson’s dis- ease and other akinetic-rigid syndromes and in cerebellar ataxia. Postural instability in Parkinson’s disease: a comparison with and without a concurrent task. Effect of cognitive and motor tasks on postural stability in Parkinson’s disease: a posturographic study. Stance control is not affected by pare- sis and reflex hyperexcitability: the case of spastic patients. The evaluation of balance in hemiparetic stroke patients using lateral forces applied to the hip. Adapting human postural reflexes following lo- calized cerebrovascular lesion: analysis of bilateral long latency responses. Human neuronal control of automatic functional movements: interaction be- tween central programs and afferent input. Medium- and long-latency re- sponses to displacements of the ankle joint in patients with spinal and central lesions. Evidences obtained from bilateral vibration of Achilles tendon in normal sub- jects and hemiparetic spastic patients during stance perturbation. Proceedings of the 3rd International Posture Symposium, Smolenice, Slovakia, 2003: 22. The effects of movement velocity, mass displaced, and task certainty on postural adjustments made by normal and hemi- plegic individuals. Shift of activity from slow to fast muscle durino voluntary length- ening contractions of the triceps surae muscles in humans. Quantitative analysis for the Romberg test (Posturography) in evaluation of peripheral vestibolopthy, acoustic neuroma and pos- terior fossa lesions. Adaptation to altered support and visual conditions during stance: patients with vestibular deficits. Postural stability of diabetic patients with and without cutaneous sensory deficit in the foot. The relationship between electromyographically documented peripheral neuropathy and falls. Fingertip touch improves postural stability in pa- tients with peripheral neuropathy. Characteristics of postural instability induced by ischemic block- ing of leg afferents. Early stabilization of human posture after a sudden disturbance: influence of rate and amplitude of displacement. Postural sway in normals and atactic patients: analysis of the stabilizing and destabilizing effects of vision. On the role of vestibular, visual and somatosensory information for dynamic postural control in humans. Effects of visual and support surface orientation ref- erences upon postural control in vestibular deficient subjects. Effect of head orientation on the diagnostic sensitivity of posturography in patients with compensated unilateral lesions. Indicators of the influence a peripher- al vestibular deficit has on vestibulo-spinal reflex responses controlling postural stabil- ity. Vestibular and somatosensory contri- butions to responses to head and body displacements in stance. Visual and vestibular contributions to pitch sway stabilization in the ankle muscles of normals and patients with bilateral vestibular deficit. Differential diagnosis of proprio- ceptive and vestibular deficits using dynamic support-surface posturography. Trunk sway measures of postural stability during clinical balance tests: effects of a uni- lateral vestibular deficit. Nonlinear analysis of orthostatic posture in patients with vertigo or balance dis- orders. Posturo-kinetic coordination on a continuously moving platform: role of proprioceptive and vestibular informations. Proceedings of the International Symposium on Gait Disorders (1999 Sept 4-6; Prague, Czech Republic). Postural responses to vi- bration of neck muscles in patients with idiopathic torticollis. Effect of proprioceptor stimulation on postural stability in patients with peripheral or central vestibular lesion. Associated postural adjustments with body movement in normal subjects and patients with parkinsonism and cerebellar disease. Balance performance, force production, and activity levels in noninstitutionalized men 60 to 90 years of age. Balance performance and step width in noninstitutionalized, elderly, female fallers and nonfallers. Reliability of four simple, quantita- tive tests of balance and mobility in healthy elderly females. Is the functional reach test useful for identifying falls risk among individuals with Parkinson’s disease? The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. Predicting the probability for falls in com- munity-dwelling older adults using the Timed Up & Go Test. Feasibility and measurement properties of the functional reach and the timed up and go tests in the Canadian study of health and aging. Age- and gender-related test performance in com- munity-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Relationship between timed ‘up and go’ and gait time in an el- derly orthopaedic rehabilitation population. The Timed “up and go” test: reliability and validity in persons with unilateral lower limb amputa- tion.
The eggs can is used to deflect brush as they dart through their be differentiated among subspecies generic 100 mg doxycycline free shipping, and those of the dense rain forest habitat doxycycline 100 mg amex. Three species are found on nominate species are characterized by fine stellate New Guinea; one also ranges in northern Australia doxycycline 200mg with mastercard. Cassowaries are solitary proven doxycycline 200 mg, the males are highly ag- gressive and these birds adapt poorly to most captive S. The neck and thighs of the male 5 nian and Kangaroo Island emus became extinct only are gray and the head is feathered. Adult emus may weigh 55 kg and in the shells of this subspecies leave the egg with a stand 1. The careful breeding of this bird since the 1870’s has Other Ratites resulted in a smaller, calmer bird that has higher quality feathers than its free-ranging relatives. Both groups are specialized Ostriches can run up to 40 mph for several miles and ground-dwelling birds that bear little resemblance can kick forward with powerful and accurate blows. This chap- Ostriches have large eyes with substantial visual ter will focus primarily on the ostrich as the model acuity, and large ear canals with a keen sense of ratite, with only occasional comment on the emu, hearing. The deviations from this model, including their size, are all adaptations to a terrestrial lifestyle. The similari- ties and differences are clinically relevant and should be familiar to the ratite veterinarian. In addition, the ostrich has a callosity distal to the pubic bone and another distal to the hock joint; both anatomic areas contact the ground in a recumbent bird. Apteria are present along the lateral body wall and provide convenient access sites for surgery and diagnostic procedures such as ultrasound. In contrast to other birds, the feathers of the ostrich function to shade the body, rather than insulate it, and an ostrich will erect the feathers when hot and flatten them when cold. Musculoskeletal System The rhea, emu and cassowary have three toes (digits 2, 3 and 4), each with four phalanges. The ostrich is the most specialized runner and has only two toes (digits 3 and 4); the metatarsal-phalangeal joint is suspended so that the standing weight is born en- tirely by the digits (Figure 48. The pubic bones of the ostrich form a solid ventral symphysis to support the weight of the abdomen (Figure 48. Because there is no need for flight, the thoracic sus 2) metatarsal phalangeal pad 3) digital cushion 4) phalangeal pad 5) toenail (modified with permission from Murray Fowler19). In the ostrich and emu, one of the tarsal bones remains unfused to the contiguous bones, which should not be misinterpreted as the knee radiographically. A surgical incision made along the midline penetrates the skin, sub- cutaneous fat (minimal) and a dense fibrous abdominal tunic. The next layer is retroperitoneal fat, which may be two to eight centimeters thick, especially in the emu. When a laparotomy is performed, the bulk of this adipose tissue should be peeled away prior to closing the body wall (Color 48. Respiration occurs by lateral excursions of the chest wall, which must be considered during an- esthesia and recovery. The normal respiratory rate in adult ostriches is 6 to 12 bpm, which may increase to 40 to 60 bpm during periods of stress, exercise or with high temperatures. The lungs and air sacs are similar to those of other avian species, but the air sac capacity is greatly reduced. The distinct visceral outlines created by the air sacs in the radiographs of psittacines are not present in ratites. Other structures of interest include the first rib (r), The femur is the only pneumatized cartilaginous extension of the sternum (c) and the humerus (h). Other structures include the femur (f), ilium (s), ischium (i) and pubic symphysis (t) Emus have a longitudinal cleft in the (courtesy of Murray Fowler,19 reprinted with permission). This insertion of the muscle on the cnemial crest of the area is particularly well developed in the female. The crest is projected craniodorsally pro- the chick, a thin membrane covers the cleft. Material deposited into the esopha- gus during tube-feeding is routinely regurgitated, creating a risk for aspiration. Consequently, gavage feeding requires that a tube extend into the proven- triculus. The proventriculus of the ostrich is a large, dilated, thin-walled structure that is easy to access surgically because it extends caudal to the ventriculus (Figure 48. In most avian species, the entire inner surface of the proventriculus secretes digestive enzymes. In contrast, the secretory region of the ostrich proven- triculus is restricted to an area of glandular tissue on the greater curvature. The distal extremity of the ostrich proventriculus passes dorsal to the ventricu- lus and empties into this organ through a large open- ing on its caudal aspect. Ventricular foreign bodies can be easily removed through an incision made into the proventriculus. The ventriculus is situated slightly to the left of the midline at the caudal border of the sternum. Though the proven- triculus and ventriculus can normally contain small stones, gastric impaction from the consumption of foreign bodies is a common problem in ratites, par- ticularly in juvenile birds (Color 48. In emus rected into the pouch causes a drumming sound in the female and a growling sound in the male. The presence of this expandable pouch may compli- cate inhalation anesthesia in mature emus. If posi- tive pressure ventilation is used to inflate the air sacs and ventilate the lungs, air may be directed into and thus inflate the pouch. Inflation of the pouch can be prevented by wrapping the lower neck with a self- adhesive bandage, taking care not to place excessive pressure on the major vessels of the neck. Proventriculus (p), ventriculus (v), duodenum (d), jejunum (j), ileum (i), ceca (c), rectum (r) and niche of these large grazing ungulates. Ratites have cloaca (cl) (courtesy of Murray Fowler, reprinted with permission19). The opening from the ventriculus to the duodenum is on the right side in all ratites. The small intestine is most important in the emu, in which it occupies most of the abdomen caudal to the ventricu- lus. In the ostrich and rhea, the elongated, well developed ceca, vis- ible immediately after entering the midline abdominal wall, course di- agonally from right to left in a caudal direction. The lumen of the ceca ap- pears sacculated as a result of spiral folds that increase the surface area in the organ and facilitate the fer- mentive digestion of fiber (Color 48. The large intestine of the ostrich is voluminous and occupies the caudal right abdomen (Figure 48. The long, large intestine is considered necessary to digest high-fiber food items. The gastroin- testinal transit time is slow in ostrich and rheas (36 hours) and much faster in emus (5 to 6 hours). Interestingly, emus produce a large portion of their energy through fermentation even though they have poorly developed ceca, a short colon and a rapid gastro- intestinal transit time. In the ostrich, the urodeum and co- prodeum are separated by a muscu- lar sphincter, making the ostrich the only bird that can urinate inde- pendent of defecation. The coprodeum is a large sac that may be covered by a dark tough membrane similar to koilin. There is no gallbladder in the ostrich, but this organ is present in the emu and rhea. As a hen reaches sexual maturity, the follicles begin to develop, so the ovary has many visible follicles of different sizes at any one time (see Color 29). Cranial division of the left kidney (k), left testicle (t) and left adrenal gland (a) (courtesy of Murray Fowler, reprinted with near the kidney. Male ratites have a phallus that serves to transport semen from the ejaculatory Ratites of both genders possess a genital prominence ducts in the cloaca of the male to the cloaca of the that extends from the ventral aspect of the cloaca. The phallus is shaped differently in ostrich, This prominence may be visualized or palpated to emu and rhea; however, the function is the same, and 25 determine the gender of any aged individual. Venipuncture can be performed using the jugular, brachial and medial metatarsal veins. The right jugular vein is larger than the left as in other avian species and is a convenient site for venipuncture or placement of intravenous catheters (Figure 48.