This report describes the introduction of case-based learning into the final-year dental programme at the Dublin Dental School. Students attended a series of one-hour sessions in groups of 8. Each group appointed a chairman for each session and a tutor facilitated the discussion. Case details were provided during the session with relevant diagnostic records. At weekly discussion sessions, the group findings and treatment options were considered. The diagnosis and treatment plans were then discussed by clinicians involved in the treatment of the case. Following the last session, the case-based learning programme was evaluated by means of a questionnaire distributed to both tutors and students. Both students and tutors rated the sessions positively. Case-based learning was found to be a worthwhile progression from problem-based learning.

The purpose of this study was to evaluate the safety and efficacy of the synthetic colloid hetastarch in dogs with hypoalbuminemia. lndividual doses of hetastarch ranged from 9 to 2 7 mL/kg, and multiple doses were used frequently. Total doses ranged from 9 to 59 mL/kg. Colloid oncotic pressure was measured in 13 dogs before and after treatment. Mean colloid oncotic pressure * SD was 9.32 f 2.35 mm Hg before treatment and 16.41 f1.61 mm Hg in 8 healthy pet dogs used as controls. The difference in these values was significant (P < .001). There was a significant increase in mean colloid oncotic pressure after the first dose of hetastarch. but there was no relationship between the dose of hetastarch and the magnitude of increase in colloid oncotic pressure. Peripheral edema or body cavity lasma colloid oncotic pressure maintains vascular vol-P ume by preventing movement of fluid from the intravascular to the extravascular space. Approximately 75% to 80% of normal plasma colloid oncotic pressure is provided by albumin.'.' Diseases resulting in hypoalbuminemia cause a decrease in colloid oncotic pressure that may be associated with loss of fluid from the intravascular space into the interstitium and body cavities. Two potential sequelae of this fluid shift, low plasma volume and pulmonary edema, can be life-threatening. The prevalence of edema and low plasma volume in hypoalbuminemic human patients is ~a r i a b l e .~The percentage of hypoalbuminemic animals with decreased plasma volume and systemic edema is not known.Less than 30% of administered crystalloid fluid is retained within the vascular space shortly after infusion in hypooncotic patients4-' Therefore, crystalloid fluid administration is often ineffective in increasing plasma volume without concurrently inducing or worsening edema in these individuals. In addition, the administration of crystalloid fluids causes a further decrease in colloid oncotic pressure, which can lead to further shifts of fluid from the intravascular to the extravascular People with low colloid oncotic pressure have a significantly higher incidence of pulmonary edema after treatment with crystalloid fluids than after treatment with colloids.2,6,8 Diuretics are often used in hypoalbuminemic animals to treat edema and body cavity effusions. Although effective in this regard, diuretics further decrease vascular volume.In hypoalbuminemic people, colloids such as 5% albumin concentrates and plasma are used. Although colloids are now being used more commonly for the treatment of shock in veterinary medicine, their use in the hypoalbuminemic animal has not been investigated. This prospective study was done to evaluate the use of the colloid hetastarch as adjunct therapy in the treatment of hypoalbuminemic dogs.Hetastarch is a colloid composed of a heterogeneous population of starch molecules made from amylopectin.l0*' ' Its structure, similar to that of glycogen, is thought to contribute to its relatively low toxicity. Its structural nature, however, makes it susceptible to rapid hydrolysis...

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The purpose of this study was t o determine the duration of action of a single dose of hetastarch. a synthetic colloid, in hypoalbuminemic dogs. Thirty hypoalbuminemic dogs (albumin concentration, 52.0 g/dL) received l dose of hetastarch each, with an average dose of 18.1 mL/kg. Doses ranged from 7.7 t o 43.9 mL/kg, with the majority of doses (n = 26) in the range of 10 t o 25 mL/kg. Dogs were allotted t o one of several groups: all dogs, dogs with acute gastrointestinal protein loss, dogs with chronic gastrointestinal protein loss, all dogs with gastrointestinal protein loss, and dogs with nongastrointestinal protein loss. Colloid oncotic pressure was measured immediately before and immediately after hetastarch administration, and 12 hours after hetastarch administration. There was a significant ( P < .001) increase in the mean colloid oncotic pressure after hetastarch treatment in all groups, except in the group with acute gastrointestinal protein loss. Twelve hours after hetalbumin (69,000 d) is the principal oncotic protein in A blood, contributing about 75% of normal colloid oncotic pressure; globulins and fibrinogen contribute the remainder.'.' Oncotic pressure of the interstitium of the lung is approximately 50% to 70% that of plasma.' The plasma colloid oncotic pressure helps maintain vascular volume and prevent edema formation, but vascular integrity and normal lymphatic drainage are also important. Interstitial edema will result if the plasma colloid oncotic pressure approaches or decreases below that of the interstitium, or if vascular permeability is altered or lymphatic drainage is compromised. The sequelae to a decrease in colloid oncotic pressure, such as pulmonary or cerebral edema, can be life threatening.Both crystalloid and colloid fluids have been used therapeutically to increase plasma volume.'^' Only about 30% of crystalloid fluids remain in the vascular space 30 minutes after admini~tration.~.' The amount of crystalloid fluid that remains in the vascular space is even less (as low as 10%) in hypo-oncotic patient^.^.' Therefore, treatment of hypooncotic patients with crystalloid solutions increases the risk of development of pulmonary and cerebral In fact, low plasma colloid oncotic pressure has been shown to be associated with increased mortality in critically ill people.',' In light of these findings, colloid solutions are being used to treat hypovolemia, especially in hypo-oncotic patients.Hetastarch is a synthetic polymer of amylopectin that has been hydroxylated,'.' and was originally developed for the effective treatment of hyp~volemia.~ During the past 20 years, hetastarch has been used in humans as an adjunct to pressure was not significantly ( P < ,001) different from the baseline mean colloid oncotic pressure in any of the groups. Twenty-three dogs (77%) survived their illness and were sent home, whereas, 7 (23%) died or were euthanized. The effect of a single dose of hetastarch on raising colloid oncotic pressure in dogs with hypoalbuminemia decreases significantly within 12 hour...

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