Relationship between joint space width and subchondral sclerosis in the osteoarthritic hand: a quantitative microfocal radiographic study

Measurement of joint space width and subchondral sclerosis from x 5 macroradiographic examination of 32 patients with osteoarthritis (OA) of the hand over an 18-month period showed that joint space loss was symmetrical in both hands. Its change showed that over a period of time narrowing progressed proximally from distal interphalangeal to proximal interphalangeal, metacarpalphalangeal and wrist joints. Sclerosis was greatest in those joints at which the largest forces were exerted across the hand in precision, power and pulp-pinch grip, respectively. Our findings suggest that constitutional factors determine the onset of cartilage changes in OA which in turn result in subchondral sclerosis, the extent of which is determined by the pattern of normal forces within the hand.

Paecilomyces varioti pneumonia in a patient with diabetes mellitus

Paecilomyces is a saprophytic soil fungus that is an uncommon human pathogen. We report a diabetic patient who developed an upper lobe pulmonary infection due to Paecilomyces varioti. This pneumonia responded poorly to oral imidazole therapy with ketoconazole. Eventual treatment of the chronic infiltrating process required administration of intravenous amphotericin B. This experience emphasizes the potential pathologic nature of this fungus when immunity is compromised by poorly controlled diabetes.

Osteophytes in the osteoarthritic hand: their incidence, size, distribution, and progression

Quantitative microfocal radiographic assessment of osteophytes in osteoarthritic hands showed that their number and area were greatest at joint margins, in the dominant hand, in the second and third compared with fourth and fifth phalanges, in the third phalanx, and in the second distal interphalangeal joint respectively. These sites correspond with those for the largest forces exerted in the hand: the dominant side, the finger tripod used in the precision grip, power grip, and pulp-pinch respectively. The greater osteophytosis on the trapezium of the nondominant first carpometacarpal joint was probably related to forces exerted during power grip. Osteophytes increased significantly in number and area during the 18 month study period.

Analysis of texture in macroradiographs of osteoarthritic knees using the fractal signature

Texture of regions of macroradiographs (x5) of six normal and five osteoarthritic knee joints, taken on a high resolution microfocal x-ray unit, are examined using mathematical morphology. Radiographs of bones are two-dimensional projections of attenuation coefficient through the three-dimensional (3D) joint structure. Visible texture represents the summation of the attenuation from numerous thin plates of bone. Where there is no organization in the trabeculae, resultant radiographs approximate a fractal surface. Varying structuring element size in mathematical morphology allows estimation of fractal dimension over a range of resolution. Variation of fractal dimension with resolution, the fractal signature, indicates how images deviate from fractal surfaces. By correct choice of structuring element, a texture analysis method using the fractal signature has been developed, tolerant to changes in image acquisition and digitization. Texture in regions of radiographs of normal tibia approximates a fractal surface with dimension 2.8 as does vertical structure in arthritic patients. In osteoarthritic knee joints, horizontal tibial trabeculae thicken. Horizontal structure in the tibia on radiographs of arthritic patients deviates from the fractal model. This is indicated by peaks in the fractal signature whose height and position match a visual assessment of the degree of arthritic change.

Hypoprothrombinemia and hemorrhage in a surgical patient treated with cefotetan

For 4 days before surgical repair of a diverticulitic colovesical fistula and for 6 days after, a 63-year-old man was treated with 2 g of intravenous cefotetan disodium every 12 hours for associated urosepsis with bacteremia. Postoperatively, the patient followed a diet of intravenous nutrition only. Uneventful convalescence was interrupted by signs of sudden major blood loss, accompanied by prolonged prothrombin time. After stabilization with packed red blood cells, fresh plasma, crystalloids, and parenteral vitamin K, laparotomy revealed a huge intra-abdominal clot, which was evacuated. This case illustrates the risk of unexpected hypoprothrombinemia and hemorrhage in a cefotetan-treated surgical patient who demonstrated none of the usual comorbid conditions generally described in patients with antibiotic-induced hypoprothrombinemia. Like cefamandole nafate, cefoperazone sodium, moxalactam disodium, and other cephalosporins containing the methylthiotetrazole side chain, cefotetan appears to pose an unusual risk of major bleeding.

A robust and accurate method for calculating the fractal signature of texture in macroradiographs of osteoarthritic knees

In osteoarthritis of the knee, horizontal trabeculae in the tibia thicken, leading to the appearance of horizontal striations on radiographs. Any attempt to understand and monitor the disease process must examine these changes. We have previously described a method of analysing the texture in these images that uses the mathematical morphology operations of dilation and erosion to calculate how image fractal dimension varies with resolution. This variation with resolution is the fractal signature. Calculation of fractal dimension should be independent of linear transformations in image values, and it is shown that careful choice of morphological structuring element is required for this. In this paper we describe the dependence of our method of calculating the fractal signature on image acquisition and digitization parameters. Errors due to variations in pixel size, X-ray exposure, and patient repositioning are small compared to the changes seen in the signature due to osteoarthritic change. Using pairs of orthogonal structuring elements, one tuned to calculate the signature due to horizontal image structure and the other for vertical image structure, texture directionality is examined. The difference between the two resulting signatures in individual knees is shown to be a measure of the change in texture seen in osteoarthritis.

Techetium 99m methylene diphosphonate bone scanning in osteoarthritic hands

In this prospective study, the radiological features characteristic of osteoarthritis of the hand were compared with the radionuclide bone scan images. A total of 32 patients was assessed at 6-monthly intervals for 18 months. Microfocal radiographs were taken at each visit. The high magnification and resolution of this technique permitted direct measurement of joint space width, subchondral sclerosis, osteophyte number and area and juxta-articular radiolucency area for each joint in the hand. Four-hour technetium 99m methylene diphosphonate bone scans were taken at 0 and 12 months and the activity of tracer uptake at each joint scored. The latter was compared with each X-radiographic feature at every visit and the changes between visits analysed. The scan scores did not correlate with any of the X-radiographic features other than osteophyte size. During the study the size of growing and remodelling osteophytes increased significantly at joints with raised or increased isotope uptake.

Mechanical measures in the prophylaxis of postoperative thromboembolism in total knee arthroplasty

Total knee arthroplasty patients are at high risk for deep venous thrombosis and pulmonary embolism. Prophylaxis against deep venous thrombosis and pulmonary embolism in these patients seems mandatory. Pharmacologic agents such as dextran 40, aspirin, and warfarin are effective but may be associated with significant complications such as drug reaction, bleeding, hematoma, and hemarthrosis. Heparin was not effective and was associated with significant bleeding complications. Mechanical methods such as continuous passive motion and sequential pneumatic compression stockings were without complications and seemed equal to or more effective than pharmacologic agents. Adding warfarin to mechanical methods did not seem to augment the antithromboembolic effect of the mechanical methods.

Quantitative microfocal radiographic assessment of progression in osteoarthritis of the hand

We studied 32 patients with osteoarthritis who had 5x macroradiographs taken of their wrists and hands at 6-month intervals over an 18-month period. The higher magnification and resolution of microfocal radiography permitted the quantitative detection of progressive changes in 4 different features: subchondral sclerosis, the number and size of osteophytes, juxtaarticular radiolucencies, and joint space narrowing. Compared with normal control subjects, subchondral cortical thickness was greater in all patients at entry and showed a variable degree of change over the study period. Osteophytes and juxtaarticular radiolucencies were present in all patients at study entry; by the end of the study, osteophytes had increased in number and area, and juxtaarticular radiolucencies had increased in area, but not in number. At entry, 44% of the patients had joint space narrowing significantly greater than that in the control subjects; by 18 months, this proportion increased to 65%. No correlation was found between subchondral sclerosis, osteophytes, juxtaarticular radiolucencies, and joint space narrowing. We conclude that in osteoarthritis of the hand, the bony changes have progressed significantly before the occurrence of radiographically evident joint space narrowing indicative of cartilage thinning.

Hemoglobin C in association with hereditary persistence of fetal hemoglobin

Hemoglobin C and hereditary persistence of fetal hemoglobin (HPFH) are an uncommon combination of hemoglobinopathies. Several tests are needed to verify this condition, among them hemoglobin electrophoresis and Kleihauer-Betke staining of a peripheral blood smear. Family studies are useful in delineating the genetics of the hemoglobinopathy but could not be performed in our case. In more confusing cases or with an unusual subtype, more extensive testing may be required. HPFH, by itself, is without clinical manifestations. It may be confused with other conditions; therefore, its presence in patients with hematologic symptoms requires more precise definition of the hemoglobin abnormality.

Application of a modified indirect fluorescent antibody test to the detection of antibodies to bovine respiratory syncytial virus in Ontario cattle

A modified indirect fluorescent antibody test for the detection of serum antibodies to bovine respiratory syncytial virus was developed. The test made use of Terasaki plastic microtiter plates in which bovine respiratory syncytial virus (Saskatchewan strain) infected Georgia bovine kidney cells were grown and fixed in situ by a modified acetone fixation procedure. Evans blue dye was used as a counterstain to reduce nonspecific fluorescence. In a study of 986 field sera from a geographically broad cross-section of mature Ontario cattle, 95% of the samples were found to be positive at or above a 1:2 dilution. No seronegative regions, counties or herds were identified. When representative samples covering a range of indirect fluorescent antibody titers were further examined by a microtiter virus neutralization assay, a significant agreement was found between the two tests. Up to a fourfold decrease in titer was observed when antigen coated plates were stored at -70 degrees C for four months. The modified indirect fluorescent antibody test for bovine respiratory syncytial virus antibody detection proved to be a rapid, practical procedure for use in the diagnostic laboratory. This study confirms that bovine respiratory syncytial virus is widespread in the Ontario cattle population and that most mature cattle can be assumed to have been exposed to this virus.

Developmental changes of oculomotor characteristics in infants when awake and in the 'active state of sleep'

Since the principal criterion for identifying sleep in the young infant is eye closure, a study was undertaken to ascertain whether fast or 'saccadic-type' movements which occur in the eyes-closed condition differ in any respect from those which are observed in the eyes-open (awake) state. Specific parameters included the amplitude-velocity relationship, the numbers and types of non-conjugate movements (disjunctive and monocular), directionality and densities (EM/min). Measurements were made on 12 infants at 4-week intervals as they progressed in age from 4 weeks to 12 weeks. The results disclosed that in the main as the infants developed, a change, if any, of ocular characteristic in the awake state was paralleled by a similar change in the eyes-closed state, although the absolute number of eye movements was higher in the eyes-open state compared to the eyes-closed state. This suggests that the eye movement characteristics, whether the eyes were open or shut, were dictated primarily by oculomotor development and the mechanics of eye closure rather than by different mechanisms of neural control effected through different states of consciousness. Of special interest was the finding that the velocity-amplitude relationship in the infant's eyes-open state was almost identical to that reported for adults in the eyes-open state whereas the value for the eyes-closed state was comparable to that of the adult's eyes-closed awake state rather than to the value obtained for adults in REM sleep.

Quality control performance in a provincial veterinary diagnostic microbiology laboratory system

A quality control exercise was carried out in a provincial laboratory system to assess the performance of nine bacteriology technologists working in six laboratories. A group of ten mock specimens were distributed to each participant. Identification of all organisms and antibiotic susceptibility testing of pathogens was requested. Of the 117 organisms distributed, 104 were correctly identified, five were incorrectly identified and eight were not reported. Overall less than 1% very major errors, less than 5% major errors and less than 10% minor errors were observed in the antibiotic susceptibility testing. Most frequent errors were associated with penicillins, aminoglycosides, polymyxin, tetracycline and fastidious organisms.

Mycetoma-like granuloma in a cat caused by Microsporum canis

A solitary subcutaneous nodule from a Persian cat consisted of coalescing mycetoma-like granulomas containing abnormal hyphae of Microsporum canis. Overlying hair follicles were heavily laden with dermatophytes but had little associated perifollicular inflammation. The complex classification of dermatophyte-induced dermal inflammatory lesions is reviewed.

Distant nontraumatic clostridial myonecrosis and malignancy

Distant nontraumatic clostridial myonecrosis in association with malignancy is an uncommon disorder, with only 14 well-documented cases previously reported in the English literature. Clostridium perfringens and C. septicum are the most common organisms, usually gaining access to the circulation through an ulcerated lesion of the small bowel or colon. A case report of this syndrome caused by C. histolyticum is presented with a review of the literature.

Central nervous system lesions in suckling mice and rats inoculated intranasally with sialodacryoadenitis virus

Suckling CD-1 and CFW mice and WI Wistar rats were inoculated intranasally with sialodacryoadenitis virus. In animals inoculated during the first week of life, there was an acute necrotizing encephalitis with malacia and minimal inflammatory cell response. In mice and rats which survived for up to 12 days post inoculation, loss of brain substance, gitter cells and occasionally mineralized debris were seen. Viral antigen was readily demonstrated in neurons and nasal epithelium in trypsin-treated, paraffin-embedded sections, and corresponded with the presence of lesions. There was no compelling evidence that sialodacryoadenitis virus invaded the central nervous system directly via the cribriform plate, and hematogenous spread was considered to be a likely route of spread to the brain. An age-related resistance to the encephalitic form was evident beginning at 10 days of age in both species. Thus it is conceivable that encephalitis could occur in young suckling rats exposed during naturally-occurring epizootics of sialodacryoadenitis.

Antibiotic resistance associated with inositol metabolism in salmonellae from ontario cattle

During 12 months in 1983-1984, Salmonellae were isolated from cattle 110 times. Salmonella typhimurium and Salmonella muenster were the most prevalent serotypes identified. All isolates were sensitive to polymyxin B. Isolates that did not produce acid from inositol were more frequently resistant to ampicillin, carbenicillin, kanamycin, sulfisoxazole, tetracycline and neomycin than isolates which could. Salmonella muenster isolates, which were almost exclusively inositol positive, demonstrated a high frequency of senstivity to commonly used antibiotics. The antibiotic sensitivities of the S. typhimurium isolates showed much greater variability, with multiple antibiotic resistance being frequently associated with those isolates that were inositol negative.

California serogroup virus infection in a horse with encephalitis

A 4-fold or greater seroconversion to the snowshoe hare serotype of the California serogroup of viruses in a horse with acute encephalitis was demonstrated by hemagglutination-inhibition, complement-fixation, and neutralization tests. The horse had a mild fever, was ataxic, had a head tilt, and was observed to circle. Chloramphenicol, dexamethasone, and B complex vitamins were administered and the horse recovered. The snowshoe hare virus is a recognized human pathogen, but it has not been associated with disease in horses. It is unknown whether horses play a role as amplification hosts for the snowshoe hare virus in nature, and further studies appear indicated.

Bovine respiratory syncytial virus infection in an ontario cattle herd

Bovine respiratory syncytial virus was recovered from the lung of a six month old calf that died during an outbreak of respiratory disease in a cattle herd in Ontario. Lung tissue removed from the calf at necropsy, performed within two hours of death, was frozen at -70 degrees C prior to virus isolation attempts. Syncytia and intracytoplasmic inclusions were demonstrated both in histological sections of the calf's lung and in stained cell culture preparations infected with the bovine respiratory syncytial virus isolate. Direct fluorescent antibody and virus neutralization tests serologically confirmed the identity of the isolate.

Virus isolation studies in an outbreak of porcine encephalomyelitis

An outbreak of central nervous system disease affecting young pigs occurred in the fall of 1981 in eastern Ontario. A diagnosis of viral encephalomyelitis was made on pathological grounds and virus isolation studies were subsequently initiated to determine the causative agent. Cultural isolation procedures using several biological systems failed to detect virus in nervous tissues from affected animals. Direct extraction of similar tissues by combined biochemical and biophysical procedures yielded nonenveloped , spherical particles with a diameter of 30 nm and a buoyant density of 1.34 g/mL in CsCl. A tentative diagnosis of enterovirus infection was made on this basis.

The influence of fibroblast-like cells derived from canine fetal hematopoietic tissues on the regulation of lymphohematopoiesis

Media conditioned by fibroblast-like cells derived from organs active in fetal lymphohematopoiesis were studied for their effects on adult granulocyte/macrophage colony-forming units (CFU-GM). Fibroblasts from fetal liver produced a factor stimulatory for CFU-GM, whereas fibroblasts from fetal marrow produced a factor inhibitory for CFU-GM which was not completely relieved by adding indomethacin to the assay. Our studies indicated that neither fetal marrow nor fetal liver produced factors affecting lymphocyte colony-forming units (CFU-L). Cell-cell interactions between fibroblast-like cells derived from fetal liver or marrow and normal adult CFU-GM were also studied. We observed that fibroblasts derived from both fetal and adult marrow inhibited colony formation, whereas inhibition in the presence of fetal liver fibroblasts was minimal. Loss of inhibitory activity by a liver fibroblast cell line over repeated passages was seen. Differential analysis of colonies formed above an adherent layer of fetal marrow fibroblasts suggested that these fibroblasts suppress myeloid/macrophage differentiation to a far greater degree than did adult marrow fibroblasts. A role in the regulation of fetal lymphohematopoiesis may be played by stromal fibroblasts.

Successful bacterin therapy in a case of chronic equine staphylococcal infection

A Staphylococcus aureus infection in a mature horse, resulting from trauma, is described, which proved refractory to antibiotic therapy directed by the results of antibiotic sensitivity testing. After a prolonged course, rapid resolution of the infection was achieved with the administration of an autogenous formalized bacterin.

Cavernous hemangioma of the adrenal gland

A case report is presented of a huge cavernous adrenal hemangioma which was the second largest reported among the 17 which have appeared in the literature. With the advent of modern and sophisticated diagnostic techniques in arteriography, ultrasound, and computerized axial tomography, preoperative recognition and diagnosis should be simplified and surgical removal carried out to rule out possible malignancy, preclude traumatic rupture, or relieve symptoms of the mass lesion.

Coronary arterial dominance associated with congenital bicuspid aortic valve

Gross examination was done of 186 hearts, principally from adults, for the nature of the aortic valve and the source of the posterior descending coronary artery (origin from the right coronary artery indicated as right dominance, origin from the left circumflex artery as left dominance). Exclusive of cases with coarctation of the aorta, the overall incidence of left coronary dominance in cases with congenital bicuspid aortic valves was 24.4%, while in cases with tricuspid aortic valves the incidence was 9.5%. There appears to be a greater tendency for left coronary arterial dominance in coarctation of the aorta than in the general population regardless of the type of the aortic valve.

Canine enteritis associated with a hemagglutinating virus

A fatal case of hemorrhagic enteritis in a young dog is described. Hemagglutination and electron microscopic studies support a viral etiology.