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Accelerated failure time regression for backward recurrence times and current durations order cialis super active 20 mg acupuncture protocol erectile dysfunction. Copenhagen (Denmark): University of Copenhagen cheap 20 mg cialis super active with amex erectile dysfunction karachi, Department of Biostatistics; 2005. Making the link: strategies for coordinating publicly funded health care coverage for children. Characteristics of emergency departments serving high volumes of safety-net patients: United States, 2000. Assessment of the national patient safety initiative: context and baseline evaluation report 1. Cox proportional hazards models for modeling the time to onset of decompression sickness in hypobaric environments. Efects of omega-3 fatty acids on cognitive function with aging, dementia, and neurological diseases. Sponsored by the Turning Point Public Health Statute Modernization National Excellence Collaborative; publication supported by a grant from the Robert Wood Johnson Foundation. Tendances recentes de la mortalite par cause en Russie 1965-1994 = Sovremennye tendentsii smertnosti po prichinam smerti v Rossii 1965-1994 [Recent trends in mortality by cause in Russia, 1965-1994]. Washington: George Washington University Medical Center, School of Public Health and Health Services, Center for Health Services and Policy; 2003 Oct. Tis analysis focuses particularly on the District of Columbia and Northern Virginia. Sample Citation and Introduction to Citing Parts of Reports Te general format for a reference to a part of a report, including punctuation: Scientifc and Technical Reports 443 Examples of Citations to Parts of Reports Rather than citing a report as a whole, separately identifed portions of a report may be cited. Chapters, sections, tables, charts, graphs, photographs, appendixes, and the like are considered parts of reports when they are written or compiled by the authors of the report. In general, most modern texts have standardized to three types of parts: fgures, tables, and appendixes. However, other names may be found for parts, including chapter, section, chart, graph, box, and photograph. Because a reference should start with the individual or organization with responsibility for the intellectual content of the publication, begin a reference to a part of a report with the report itself, then follow it with the information about the part. For instructions on citing one volume of a report published in multiple volumes, see Chapter 2B Individual Volumes of Books (Chapter 2B(1) Individual Volumes With a Separate Title but Without Separate Authors/Editors or Chapter 2B(2) Individual Volumes With a Separate Title and Separate Authors/Editors) and examples 7-8 below. Reports may contain charts, fgures, and other illustrative material that have been reproduced with permission from other sources. Citation Rules with Examples for Parts of Reports 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. Report (R) | Name and Number/Letter (R) | Title (R) | Location (Pagination) (R) 444 Citing Medicine Report (required) • Cite the report according to Chapter 4A Entire Reports Name and Number/Letter of the Part for a Report (required) General Rules for Name and Number/Letter • Enter the name of the part, such as Chapter, Table, Figure, or Appendix • Do not abbreviate names. Risunok 6 Parartema 4 • Romanize or translate titles in character-based languages (Chinese, Japanese). Ichiran-hiyo 3 or [Table 3, ] • Provide an English translation, if possible, afer the original language title, placed in square brackets Box 56 continues on next page... Anexo, Creacion de las especialidades medicas [Appendix, Beginnings of medical specialties]; p. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Language Chapter Table Figure Appendix Section Spanish Capitulo Tabla Figura Apendice Seccion Parte Box 57. In this case, give whatever name is used for the part and follow it with a comma and the title. Part of a report in language other than English Scientifc and Technical Reports 447 Title of the Part for a Report (required) General Rules for Title • Enter the title of the part as it appears in the report • Capitalize only the frst word of a title, proper nouns, proper adjectives, acronyms, and initialisms • End title information with a semicolon and a space Specific Rules for Title • Non-English titles for parts • Titles containing a Greek letter, chemical formula, or other special character • No title appears Box 59. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Figure 3, Infuence of seed extract of Syzygium Cumini (Jamun) on mice exposed to diferent doses of γ-radiation; p. Figure 3, Infuence of seed extract of Syzygium Cumini (Jamun) on mice exposed to diferent doses of gamma-radiation; p. Occasionally a part does not have a formal title, only a legend (explanatory text) for the table, fgure, appendix, or other part. Appendix, [Excerpts from "Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals"]; p. Part of a report in language other than English 450 Citing Medicine Location (Pagination) of the Part for a Report (required) General Rules for Location (Pagination) • Begin location with "p. When this occurs, give the total number of pages of the part you wish to cite, placed in square brackets, such as [5 p. Occasionally, a table, fgure, appendix, or another part will appear on a page that is not numbered. Figure 5, Modeling the risk of in-hospital death following lung resection; [preceding p. Table 5-1, Prevalence (%) of diagnosed and undiagnosed 452 Citing Medicine diabetes among adults aged 45-64 years, by race/Hispanic origin- United States, 1986-97; p. Cox proportional hazards models for modeling the time to onset of decompression sickness in hypobaric environments. Focus on Children community planning manual: needs assessment and health planning for children, including children with special health care needs. Chicago: University of Illinois at Chicago, Division of Specialized Care for Children; 1996 Oct. A national survey of methyl tert-butyl ether and other volatile organic compounds in drinking-water sources: results of the random survey. Figure 5, Concentrations of naphthalene in all source-water and feld quality-control samples analyzed for the Random Survey, plotted sequentially by date and time of analysis; p. Evaluation of the potential for bovine spongiform encephalopathy in the United States. Seventh report of the Good Neighbor Environmental Board to the President and Congress of the United States. New voices in rural medical practice: analysis of qualitative data from the National Rural General Practice Study. Other part of a report, without name or number/letter New Jersey 2005 hospital performance report: a report on acute care hospitals for consumers. One volume of a report Healthcare hazard control: environmental safety and security in healthcare facilities. Te health care challenge: acknowledging disparity, confronting discrimination, and ensuring equality.

The Bacterial infections of the kidney often occur secon- paired kidneys are located in the ventral renal fossae dary to septicemia but may also result from bacteria of the synsacrum buy 20 mg cialis super active www.erectile dysfunction treatment. Staphylococcus cheap cialis super active 20 mg otc erectile dysfunction in early 30s, Strepto- abdominal air sacs, which extend as diverticuli be- coccus, Listeria, Escherichia coli, Klebsiella, Salmo- tween the kidneys and the pelvis. This finding ex- nella, Yersinia, Proteus, Citrobacter, Edwardsiella, plains why, at least in Psittaciformes, a rim of air can Enterobacter, Morganella, Providencia, Serratia, be seen dorsal to the kidneys. Bacterial cultures of blood and raphically because the caudal part is superimposed urine may reveal the causative organism. On a ventrodorsal terial infections often cause monocytosis that can be radiograph, the kidneys are superimposed by the demonstrated on a peripheral blood smear. This is considered an abnormal finding that occurs frequently in African Grey Parrots. Adult trematodes of Tanaisia some viruses like avian polyomavirus and infectious bragai can be found in collecting ducts of chickens, bronchitis virus in chickens demonstrate a trophism turkeys and pigeons. Other viruses that have been associ- ated with renal lesions include Newcastle disease Noninfectious Diseases virus, paramyxovirus of pigeons, reoviruses, viruses belonging to the leukosis/sarcoma group and herpes- Congenital Defects viruses (eg, Pacheco’s disease virus and pigeon her- Agenesis and hypoplasia of part of the kidneys have pesvirus). Renal Mycotic Infections cysts have also been described and may be congenital Renal infarction as a complication of mycelium inva- in origin (Color 21. Diagnosis can be made with sion of blood vessels secondary to pulmonary mycotic urography and laparoscopy. Abdominal air sac aspergillosis with renal involvement per continuitatem has also Metabolic Disorders been reported (Color 21. In the latter case, is- Hypervitaminosis D and elevated dietary calcium chiatic nerve involvement resulted in unilateral pa- can both cause hypercalcemia and lead to deposition ralysis. Parasitic Infections This condition can be detected radiographically, and Granulomatous nephritis due to Isospora, Crypto- the history may indicate oversupplementation of cal- sporidium, Microsporidium an d Encephalitozoon cium or vitamin D in the diet. Visualization of the kidneys is enhanced by the presence of calcium phosphate crystals. Pneu- monia and consolidation of the left air sacs (arrows) are also present (courtesy of Marjorie McMillan). Suggested causes include excess dietary calcium, low phosphorous and infectious bronchitis virus. Unilateral or bilateral ureteral concrements of calcium urate can lead to postrenal renal failure. A diagnosis may be possible with cloacal palpation, radiography, excretory urography and endoscopy. Hypovitaminosis A can cause metaplasia of the epi- thelium of the ureters and collecting ducts and de- creased secretions of mucus in these structures. Amyloidosis Renal amyloidosis often occurs in Anseriformes in con- junction with amyloidosis of other organs (eg, liver) secondary to chronic inflammation. There is a deposi- tion of amyloid A, a degraded fragment of an acute phase reactant. In ducks, renal amyloidosis can lead to massive proteinuria and nephrotic syndrome due to severe glomerular damage. Prerenal Renal Failure Salt (NaCl) poisoning has been documented in vari- Treatment of prerenal renal failure caused by dehy- ous species. Salt poisoning via drinking water can dration or shock is usually successful; however, the lead to right ventricular failure and ascites. Salt challenge is diagnosing and treating the initial cause poisoning via food leads to acute renal failure with of dehydration. Clinical signs include volume with intravenous fluids will usually restore polydipsia and polyuria, or anuria if urate impaction normal renal function within hours (see Chapter 15). Successful extracor- Neoplasia poreal shock wave lithotripsy for removal of uric acid Budgerigars have a high incidence of primary renal concrements in the urinary tract has been reported tumors, especially adenocarcinoma and nephrobla- in a Magellanic Penguin and may be attempted in stoma (younger birds) (Color 21. Unilateral or bilateral paralysis caused by compression of the ischia- Once a diagnosis of acute (reversible) renal failure is tic nerve is a common clinical sign associated with renal made, immediate and aggressive therapy is indi- malignancies in birds (Color 21. Suggested therapy ment is common when a renal mass causes caudoven- for managing uric acid nephropathy in mammals tral displacement of the ventriculus or ascites. A renal provides some insight into the treatment of birds tumor may be radiographically detectable with or with- with a similar condition but different etiology. Acute out the use of barium sul-phate to differentiate the oliguric renal failure associated with hyperuricemia margins of the gastrointestinal tract. A bilateral the administration of cytotoxic drugs or irradiation, obstruction will rapidly lead to visceral gout. Unilat- whereby the dissolution of a neoplastic mass liber- eral obstructions will lead to atrophy and compensa- ates a heavy load of nucleic acid that must be catabol- tory hypertrophy of the contralateral kidney. The uric acid excre- tion rises suddenly, uric acid precipitates in renal Renal Hemorrhage tubules and acute oliguric renal failure ensues. Con- Renal hemorrhage can be caused iatrogenically dur- tributing factors include excretion of an acid urine ing endoscopy if improper technique is used. Spor- secondary to metabolic acidosis, dehydration and the adic renal hemorrhage in male turkeys and Psittaci- use of uricosuric drugs (adrenocorticosteroids). It can also occur as a taining a high alkaline urine flow by infusing manni- complication of renal pathology (eg, tumor). The bird showed signs of depression 18 hours after the third dose of allopurinol was given. A diagnosis of renal tubular nephrosis Allopurinol caused by oxypurinol, xanthine or uric acid deposits 24 A recent study has demonstrated that oral admini- in the tubuli was made. Intravenous and subcutane- stration of allopurinol does not prevent the occur- ous saline, corticosteroids and furosemide (1 mg/kg) rence of physiologic postprandial hyperuricemia in were administered twice daily in an attempt to re- Red-tailed Hawks. Urine production was restored administration of allopurinol caused a severe hype- and, after 24 hours, plasma uric acid concentration ruricemia and induced gout in three out of six, clini- had decreased to 3,814 µmol/l. Plasma uric to reduce plasma uric acid concentration in man with acid had decreased to 1,639µmol/l 72 hours later. The results of this study seem to bird fully recovered after two weeks of intensive indicate that allopurinol is contraindicated for the treatment with intravenous fluids and supportive treatment of hyperuricemia in Red-tailed Hawks. Assessment of fluid re- therapy based on single observations in individual quirements can be based on this general outline but birds must be cautiously applied to the management must be monitored by daily weight determination of any avian disease (including gout) until research and observation for clinical signs that would indicate can determine that a therapy is safe. In patients that are anorectic and not receiving assisted feedings, some The extreme renal tubular nephrosis observed fol- allowance should be made to account for tissue ca- lowing allopurinol administration in Red-tailed tabolism. Sodium, potas- purinol, the relatively insoluble and nephrotoxic end- sium and protein intake should be discontinued and product of allopurinol. Alternatively, renal damage calories should be given in the form of fat and carbo- might have been caused by the deposition of xanthine hydrates. Furosemide of uric acid, and concentrations of these substances should be used in an attempt to restore or increase increase when the xanthine oxidase inhibitor, al- urine flow and potassium excretion.

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In general discount cialis super active master card erectile dysfunction treatment in trivandrum, hand-raised Umbrella Cockatoos tend to seek modification support (see Chapter 4) discount cialis super active online mastercard erectile dysfunction doctor in houston. Larger macaws are beautifully colored and playful, but they can be quite loud, tend to be destructive and usually develop a relation- Some species such as Rose-breasted Cockatoos, large ship with an individual family member. The “mini” macaws, smaller Amazon par- bird are influenced by genetic factors interacting rots, Pionus parrots, Poicephalus species and Um- with aspects of management and disease. Some at- brella Cockatoos are less likely to develop these tributes are common to most individuals within a traits. Others are peculiar to particular strains of birds by an effective socialization program when the birds that have been selectively bred over many gen- bird is young. Determining the physical and behavioral attributes of related birds, especially the parents and siblings, Taming Companion Birds can be of value in selecting a companion bird. It Young, hand-raised Psittaciformes adapt readily to should be noted that large Psittaciformes have the new surroundings and handling procedures. They capacity to live as long as humans, and adding a should be exposed early in life to novel situations (eg, large psittacine bird to the family should be under- car travel, hospital visits, multiple visitors in the taken as a life-long commitment. Knowing the ge- household, other household pets) so that they are netic background and characteristics of the relatives well adjusted to these events. Older birds, especially of a bird is particularly critical when choosing a pair wild-caught adults, are usually very difficult to tame. It should be noted that mu- tations in color are generally the result of continued Bird Maximum Average inbreeding. In selecting for particular color muta- Gouldian Finch unknown 4 tions (eg, lutino cockatiels), scant priority is placed Zebra Finch 17 5 on other important attributes, so that decreased dis- Canary 20 8 ease resistance, disorders, reduced longevity and Mynah 8 3 birth defects often result. This is most apparent when comparing the Rosella 15 3 different breeds of canaries and budgerigars. Cur- Eclectus Parrot 20 8 rently, show budgerigars are approximately twice the Galah 20 5 mass of their free-ranging conspecifics. Attempts to Bare-eyed Cockatoo 40 15 produce larger birds has also led to numerous unde- sirable characteristics including feathering that im- Sulphur-crested Cockatoo 40 15 pairs flight, interferes with normal ambulation, ac- African Grey Parrot 50 15 cumulates excrement pericloacally and protrudes Pionus parrot 15 5 across and sometimes into the cornea. Amazon parrot 80 15 Macaw 50 15 Longevity Conure 25 10 Longevity, the potential maximum duration of life for Grey-cheeked Parakeet 15 8 a species, has little relevance to exhibition or show Superb Parrot 36 6 bird breeders (who discard imperfect nestlings and older breeding birds) but should be of critical impor- Domestic pigeon 26 15 tance to the companion bird client. Some highly bred strains of birds may have life expectancies one-third Selected Species Recommendations to one-tenth the duration of “wild-type” or less highly The Grey-cheeked Parakeet, Dusky and Maroon-bel- inbred individuals of the same species. For example, lied Conures and Monk Parakeets are reputed to be it is believed that inbreeding has contributed to the relatively resistant to common diseases and are reduction in the life expectancy of cockatiels from a longer-lived than most cockatiels, budgerigars and record of 32 years to the present-day average of four lovebirds. When seeking a healthy companion bird scribed as quiet but playful; the conures are not as that has the greatest potential of reaching its full life quiet, yet they can be tame and affectionate; and the expectancy, clients should avoid highly inbred birds Monk Parakeet is considered docile, quiet and rela- in favor of the wild-type characteristics. Other bird species Currently, the available information on the popula- that are considered relatively quiet include the Ring- tion dynamics of free-ranging birds and those main- necked Parakeet, Pionus species, Hawk-headed Par- tained as pets is sparse. It is doubtful that the longev- rot, Caique, Dusky-crowned Conure, Senegal Parrot, ity for many companion bird species is known Jardines Parrot, Cape Parrot, Meyer’s Parrot, Red- because of a lack of scientifically derived diets and bellied Parrot and Brown-headed Parrot. An increase in longevity aviculturist or pet retailer and checking several ref- data will require that aviculturists and avian veteri- erences are well worth the effort. This is a frequent practice with ticularly those that are likely to be illegal imports Amazon parrots that enter the United States from (smuggled), should always be avoided. A veterinarian is well advised to seek legal advice in developing a form to be used as a certificate of exami- nation. The term “health certificate” should be Choosing a Healthy Bird avoided because it is impossible to certify “health. The ex- family are: pectations of a dealer or client regarding a veterinary examination may be quite different, and require- Obtaining the bird from a reputable breeder who ments and liabilities are likely to vary among coun- specializes in the particular species or genus of tries and states. Obtaining the bird from a reputable source who Clients should always be offered state-of-the-art di- works in close liaison with an avian veterinarian. It is important to note in a patient’s medical Obtaining a well adapted companion bird from an record what services were offered to a client and individual who is no longer able to provide for the which of those services were chosen, in order to pre- pet (due to age, moving, finances). Because the results Parameters that increase the likelihood of adding a of a single diagnostic test are not absolute, the prac- diseased, unhappy bird to the family are: titioner must combine the values reported by the Obtaining a wild-trapped bird. When all the data on a patient is collected and evalu- Obtaining a bird with an asymmetrical beak, ex- ated, the practitioner can state only that in his opin- cessively scaly legs, twisted digits, missing toes, a ion, there were no detectable abnormalities at the blocked nostril, slight swelling around the eyes, time of testing. If the bird’s enclosure is too large to move (in most situ- Identifying an overtly ill bird in a retail outlet should ations it should be), then clean butcher’s wrap or any caution the consumer to purchase a bird from an- non-absorbent paper should be placed on the bottom other source. All species dis- Aggression Golds and miniature macaws) cussed are susceptible to malnutrition, bacte- Cannibalism Polyomavirus rial infections, fungal infections and toxicities. Unless a species has a Coagulopathies particular propensity or a characteristic presen- Megabacteria Magpies, Australian tation, these problems are not mentioned. Heat stress Soft pliable beaks and bones in juveniles Lovebird pox (parathyroid gland dysfunction) Diseases mentioned may be common in some Epilepsy (idiopathic) Spiruroid throat worms localities or bird populations, whereas the Viral infections Scaly leg mite (Knemidokoptes-like) same diseases are rarely encountered in other Obstetrical problems (egg binding) localities or populations. Mynahs Bilateral clenched foot syndrome Hepatopathies Capillariasis Iron storage disease Cirrhosis of liver appointment. The Home Environment A clean, padded cardboard box or carrying crate with adequate ventilation is suitable for most short peri- ods of transportation. The bird should be maintained at an ambient temperature of 70° to 80°F and should Quarantine never be left unattended. Containers that have been previously used to transport birds must be cleaned If a client already has companion birds, any new and sterilized before reuse (see Figure 2. Carry- additions to the household should be isolated (quar- ing containers constructed of wood should be used antined) for six to eight weeks. During this quarantine period, the bird should be examined by a veterinarian and any identified prob- For safety, the bird should remain in some type of lems should be corrected. The enclosure should be clean grated into the post-purchase examination procedure and easy to service and should be constructed of a (see Chapter 6). Enclosures should be used to house the bird when no one is home and at night; therefore, the enclosure should be secure and Enclosures free of potential traps. Gaps between sections of the Enclosures for birds come in numerous shapes, sizes, enclosure can entrap toes, beaks or wing tips and styles and materials. Many are designed primarily to should be minimal in a well designed enclosure (Fig- appeal aesthetically to the client but fail dismally to ure 1. The materials or de- appear to be the best substances for the bottom of the signs of some enclosures may actually create a health enclosure. The design of the Bubble-shaped (domed plastic, usually with peat substrate) enclosure should minimize the likelihood and possi- Small rectangular or cuboidal shape Short or tall cylindrical shapes of small diameter (< 2 meters) bility of a bird having access to its own or other birds’ Bamboo construction droppings. Highly convoluted enclosures (ornately designed) Multiple crevices and hard to clean areas Position of Enclosure Enclosures that prevent full extension of the wings Stacked perches that result in fouling of the lower perch A bird’s enclosure should be positioned so that at Perches placed so the bird fouls its water or food container least some of the perches allow the bird to be at or Galvanization (lead/zinc poisoning) Metal water containers soldered at the seams (lead poisoning) above eye level of standing family members. Birds Copper fittings (copper poisoning) are generally more secure at this level than lower Internal hooks (trauma), sharp objects or sharp edges and are less likely to develop dominant or aggressive Fine, easily chewable mesh construction Little room to hop (preferably to fly) between two perches tendencies than if they are placed at higher levels.

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Toxins Lower Respiratory Disease Clinical Presentation Coughing buy cialis super active without prescription erectile dysfunction 23 years old, dyspnea cialis super active 20mg without a prescription ayurvedic treatment erectile dysfunction kerala, open-mouthed breathing, tail-bobbing, low exercise tolerance, depression Diagnostic Techniques History Auscultation of lungs and air sacs Radiography Laparoscopy Culture, flush or biopsy Visualize lungs and air sacs Nonrespiratory Diseases Foreign Body Parasites Air Sacculitis Pneumonia Respiratory Allergy with Respiratory Signs Inhalation Abscess 1. Once an infection is resolved and the sinus Bacterial and fungal organisms are commonly asso- pathways are patent, the collapsed sinus should re- ciated with acute and chronic air sac infections. Within a flock of one hundred six- air sacs are poorly vascularized and have no clear- month-old emus, two birds developed this syndrome, ance mechanism (mucociliary blanket), which com- suggesting a low prevalence of the problem in a given plicates the treatment of air sacculitis. Surgical debridement may be necessary to re- The inhalation of foreign bodies (seeds, granuloma- solve air sac infections that result in the formation of tous plaques, splinters and toys) occasionally occurs masses. A thorough en- Subcutaneous emphysema can occur following dam- doscopically assisted examination of the nares, cho- age to any air sac system but is most common with ana, glottis, trachea and syrinx is helpful in the damage to the cervicocephalic, abdominal or caudal diagnosis of foreign body inhalation. Trauma, malnutri- lomas, abscesses and papillomas (glottis and choana) tion and infectious agents have been implicated as may cause varying degrees of dyspnea. In addition, the cervicocephalic air sac may dis- The methods chosen to remove a foreign body will tend as a result of rhinitis, which causes occlusion of depend on the size of the patient. Some foreign bodies that cannot be removed deflate but will typically reinflate with subsequent by grasping may be flushed out of the trachea by respiratory cycles. Initially, these problems can be holding the bird upside down and infusing fluids managed by wrapping the area with a loose, self-ad- through a small tube placed in the trachea or through herent bandage. If the problem persists, long-term a transtracheal needle passed caudal to the mass. In management can be achieved by inserting a Teflon some smaller birds, the distance to the syrinx can be stent in the dorsal wall of the air sac that allows air estimated and marked on an appropriate-sized tube. In some cases, the damage to the sac will The tube is then passed blindly to this predetermined repair itself and the stent can be removed. In other level and suction is applied to remove accumulated cases, the stent must remain in place permanently debris. Proliferative Tracheitis Product Mentioned in the Text Dyspnea, rales, pseudomembranous tracheitis, con- a. Antiviral therapy utilizing acyclovir may be helpful along with supportive ther- apy and antibiotics. The bird was successfully managed by making an incision into the air sacs allowing them to deflate. Mem Soc Zool Franc 2:260-318, tranasal granuloma from an African Some unofficial thoughts on avian vi- 40. Perry R, Gill J, Cross G: Disorders of gram negative bacterial isolates from pp 133-138. All these organs release hormones into the bloodstream, which act on target tissues by interacting with receptors on the surface of the cell (peptide hormones) or within the cytoplasm or nu- cleus of the cell (steroid hormones). Endocrine system abnormali- ties may be more frequently diagnosed as practitio- ners expand their working knowledge of normal avian endocrinology, and appropriate clinical diag- nostic tests can be used to document endocrine ab- normalities. Confirmation of the diagnosis may be diffi- cult once replacement therapy is initiated, and im- proper or inadequate endocrine therapy can be fatal. Obesity is a good example of a clinical sign that is often misdiagnosed as an endocrine disorder (hypo- thyroidism) in birds, but is nearly always caused by J. Feather abnormalities have also been reported in association with endocrine disorders without supporting evi- dence for an etiology. Polydipsia and polyuria can be of endocrine origin, but may also be psychogenic in origin. Psychologic factors and generalized organic diseases can profoundly affect endocrine function. Suppression of gonadotropin synthesis and reproduc- tive failure may occur with environmental stress, and there can be an inadequate production of vita- min D in chronic renal failure leading to renal secon- dary hyperparathyroidism. Occasionally, failure of a target organ to respond to hormones may mimic endocrine disease (eg, nephrogenic diabetes in- sipidus, pseudohyperparathyroidism). Furthermore, in man, domestic mammals and possibly also in birds, a number of endocrine syndromes may develop in association with tumors of non-endocrine origin, which form hormones that have a biological activity similar to the natural hormones (eg, paraneo- plastic syndromes, ectopic hormone production). The hypothala- dency among veterinarians to extrapolate knowledge mus is extensively innervated by ascending and de- of small animal endocrinology to birds, differences scending afferent fibers from the rest of the central between avian and canine endocrinology will be high- nervous system. Therapeutic measures are not given for diseases that The supraoptic and paraventricular nuclei form the have not been reported in birds. Guidelines for spe- neurohypophyseal hormones, mesotocin and vasoto- cific treatments of all endocrine abnormalities can be cin, which are transported by axoplasmic flow and found in human and veterinary textbooks of internal stored in depots in the neural lobe. Axons terminat- ing at the median eminence discharge their chemotransmitters into a portal system of blood ves- sels, which drain into the anterior pituitary gland. This is accomplished by decreasing the The hypothalamus is a relatively small structure glomerular filtration rate through constriction of the that occupies about three percent of the total brain afferent arterioles of reptilian-type nephrons, and by volume and forms a large portion of the ventral increasing the permeability of collecting ducts of diencephalon. Anteriorly, the most sponse to plasma osmolality changes, which are reg- prominent are the preoptic nucleus, supraoptic nu- istered by peripheral and central osmolality recep- cleus and paraventricular nucleus. In other avian species, prolactin induces tration is low during egg laying, incubation and care broodiness and suppresses ovarian function directly for the chicks. Prolactin is toward the end of the chick-rearing period to prepare released after infusion of hypertonic NaCl solutions, the hen for the next laying cycle. After 50 days of being exposed to long daylight lamic-hypophyseal-adrenocortical axis in birds, and periods, the birds become refractory to photostimula- plasma concentrations of corticosterone must be tion. These chemotrans- (eg, growth promotion, lipolysis, inhibition of glu- mitters can have a stimulating or an inhibiting ac- cagon-induced lipolysis). Contrary to the situation in mammals, prolactin is Considering the large number of diseases associated under stimulatory hypothalamic control. Diseases may be caused by hypo- or hypersecretion Hormonal Involvement of one or, more commonly, several of the hypotha- in Avian Growth and Development lamic or pituitary hormones. These alterations in A number of hormones play a major role in the con- secretion may be caused by tumors that are primary trol of growth. This makes it factor or thyrotropin releasing hormone are not ob- possible to distinguish between a primary disorder of served until three weeks into incubation. With this test, differentiation between central If these signs are present and a bird dies, the pituitary gland diabetes insipidus, nephrogenic diabetes insipidus, should be submitted for histopathology. Pituitary tumors have been associated with a ten-fold weight increase of the pituitary Calcium Metabolism gland. Other hormones, however, also alter erigars and avian leukosis virus, however, has yet to calcium metabolism, and the amounts of calcium and be demonstrated. In companion birds, erigars and cockatiels are related to hormonal imbal- the parathyroids are normally visible as light-colored ance (eg, polyuria, polydipsia, reproductive failure, areas at the caudal end of the thyroid glands (see obesity and feather structure and pigmentation ab- Anatomy Overlay). The main tools that have been normalities) and to compression of surrounding nerv- used for studying parathyroid function in birds have ous tissue (eg, stupor, blindness, uni- or bilateral been parathyroidectomy and the use of heterologous exophthalmus, convulsions). Calcium excretion in the urine is decreased by obesity was characterized by an accumulation of adi- increasing tubular reabsorption of calcium, while cir- pose tissue beneath the skin of the breast and abdo- cumstantial evidence suggests that calcium resorp- men as well as in the peritoneum and mesentery. The net result is a glucose concentrations exceeded 1000 mg% with one phosphate diuresis and a decrease in plasma phos- value reaching 1768 mg%. It appears, rather, to control hypercalcemia and to pro- tect the skeleton from excessive calcium resorption. The mechanism of conversion in birds that lack a uropygial gland has not been proposed.