Use of a balloon occlusion catheter to facilitate transarterial coil embolisation of a patent ductus arteriosus in two dogs

Two dogs with a history of coughing and exercise intolerance were suspected to have a patent ductus arteriosus (PDA), and the presence of a type III PDA was confirmed by radiography, electrocardiography, ultrasonography and angiography. Transarterial coil embolisation was carried out by using a modified technique. An occlusion balloon catheter was inserted through a femoral vein and placed at the pulmonary side of the ductus before the embolisation coils were put in place. Both dogs remained healthy during a follow-up period of nine months.

Magnetic resonance arthrography of the cubital joint in dogs affected with fragmented medial coronoid processes

OBJECTIVE

To evaluate efficacy of intra-articular injection of gadolinium tetra- azacyclododecane tetraacetic acid (gadolinium-DOTA) for delineating fragmented medial coronoid processes (FMCP) and lesions on the medial aspect of the humeral condyle (MAHC).

SAMPLE POPULATION

14 cubital joints in 9 dogs.

PROCEDURE

Magnetic resonance imaging (MRI) was performed with and without intra-articular injection of a solution of 2 mmol of gadolinium-DOTA/L. Arthrographic images obtained after injection of contrast medium were compared with those obtained without contrast medium. Evidence of contrast medium around or in the medial coronoid process and infiltration of contrast medium in subchondral bone lesions was recorded. Twenty-four hours after imaging, arthroscopy was performed, and lesions detected were correlated with results of MRI.

RESULTS

An abnormal coronoid process was diagnosed in 13 of 14 joints. A fragmented process (free) was seen in 7 of 14 joints; nondisplaced mineralized medial (in situ) coronoid processes were evident in 4 joints; and nondisplaced unmineralized medial coronoid processes were evident in 2 joints. Lesions on the MAHC were diagnosed in 4 of 12 joints. In 5 joints, a hyperintense signal resulted from contrast medium that infiltrated between the fragmented process and ulna. In 2 joints, contrast medium did not infiltrate completely around the process and was stopped by an isointense structure (ie, abnormal cartilage). Subchondral bone lesions were enhanced by use of contrast medium.

CONCLUSION AND CLINICAL RELEVANCE

Use of arthrography enabled us to identify FMCP easily, but did not provide important additional information about changes on the medial coronoid process, compared with MRI performed without contrast medium.

Probable trigeminal nerve schwannoma in a dog

A 7-year-old male Husky dog developed atrophy of the right masseter muscle and pruritus of the right side of the face. A myogenic origin was excluded using muscular biopsy. Electrophysiologically, there was involvement of the motor and sensory fibers of the trigeminal nerve, suggesting a lesion located between the brainstem and the trigeminal ganglion. On MRI examination, a nodular mass was detected in the right caudal fossa. This mass was characterized by intense enhancement after injection of contrast medium. Because of the progressive clinical signs, electrophysiology, and MRI results, a presumptive diagnosis of a trigeminal nerve schwannoma was made. The animal's condition improved slightly with corticosteroids. The dog underwent euthanasia 3 months after initial presentation. Necropsy was not performed.

Comparison of spin echo, gradient echo and fat saturation magnetic resonance imaging sequences for imaging the canine elbow

Two comparison studies were performed. In the first conventional spin-echo (T1- and T2-weighted) sequences and a three-dimensional (3-D Fourier transform [3DFT]) echo gradient fast-imaging sequence were compared for imaging the canine normal elbow joint. In all three sequences, there was an isointense signal of the articular cartilage and a hyposignal of the subchondral bone, as compared with the muscles. The medial coronoid process of the ulna was clearly seen on the dorsal plane images, it appeared with a homogenous low-intensity signal. Its articulation with the radius was clearly outlined. In a second study, the 3DFT echo gradient fast-imaging sequence was compared to a fat saturation sequence on normal shoulder and elbow joints. Elbows were imaged with and without injection of saline, in an attempt to show the opposing cartilaginous articular surfaces. This distinction was possible in the shoulder joint but not in the elbow because of insufficient spatial resolution. On the three MRI sequences compared, gradient echo fast imaging with steady-state precession (GE FISP) sequence was found to be the most suitable for imaging the canine elbow joint.

Laparoscopy in the diagnosis and management of Crohn's disease

We have tried to evaluate the role of laparoscopy and laparoscopic-assisted surgery in the management of Crohn's disease. Over a 4-year period, we had 38 patients, of which 23 patients were suspected to have Crohn's disease and were admitted for diagnostic laparoscopy while 15 patients had already had a biopsy confirmation of Crohn's disease in the past and were admitted for specifically planned procedures. In the first group of 23 patients, 11 were found not to have Crohn's disease. In the remaining 12 patients, three were proven to have Crohn's disease, but no surgical procedure was undertaken. The remaining nine patients underwent laparoscopic-assisted procedures, of which two required conversion to a laparotomy because of intra-abdominal abscesses. All 15 patients in the second group underwent laparoscopic or laparoscopic-assisted procedures. In total, 14 patients were spared a potential diagnostic laparotomy and could go home the next day. The remaining 24 patients underwent procedures requiring longer hospital stays; five had a purely laparoscopic procedure, 17 had a laparoscopic-assisted procedure, and two required a laparotomy. Although there was little difference in the median stay for patients treated laparoscopically or by laparotomy, it is thought that the extent or severity of the disease process influenced the length of the stay rather than the approach used. The complication rate was similar to that found in Crohn's patients undergoing open surgery. It remains to be seen whether those in the laparoscopically treated group have less adhesive complications than those treated by laparotomy. It is our belief that laparoscopy is a valuable aid in the diagnosis of Crohn's disease. It remains to be proven whether or not laparoscopic-assisted surgery will be of significant value in the treatment of this condition.

Comparison of radiography, magnetic resonance imaging, and surgical findings in dogs with elbow dysplasia

OBJECTIVE

To describe the magnetic resonance imaging (MRI) appearance of medial coronoid process and humeral condyle lesions in dysplastic cubital joints and to compare survey radiography and MRI for evaluation of fragmented medial coronoid process (FMCP) and lesions of the medial aspect of the humeral condyle (MAHC).

ANIMALS

18 dogs with elbow dysplasia.

PROCEDURE

Radiography of 22 cubital joints was performed. The 22 joints then underwent MRI. The scans were evaluated with regard to the shape and signal of the coronoid process; articular cartilage change, subchondral bone disruption of the MAHC. Surgical findings were used as the standard to calculate accuracy, sensitivity, specificity, and positive- and negative-predictive values for specific diagnosis of FMCP (free fragment) and lesions of the MAHC.

RESULTS

At surgery, 31.8% of the joints had FMCP (free), 36.4% had nondisplaced unmineralized coronoid process, and 27.2% had nondisplaced mineralized coronoid process. Eleven joints had lesions of the MAHC, and wear lesions were observed in 41% of the joints. On radiography, FMCP (free) was visualized in 9% of the joints and lesions of the MAHC were observed in 23%. MRI had the highest accuracy (95.5%), sensitivity (100%), and negative-predictive value (100%) for detection of FMCP (free), and had accuracy (91%), sensitivity (87.5%), specificity (92.5%), and positive (87.5%)- and negative (92.5%)-predictive values for detection of nondisplaced unmineralized coronoid process.

CONCLUSIONS AND CLINICAL RELEVANCE

Compared with radiography, MRI was useful for detection of nondisplaced unmineralized coronoid process; images consistently correlated with surgical findings. The technique is accurate and especially useful when radiographic findings are inconclusive.

Treatment of patent ductus arteriosus by placement of intravascular coils in a pup

A 3-month-old female mixed-breed pup was referred for evaluation and treatment of patent ductus arteriosus (PDA). Selective angiography was performed to confirm the diagnosis. A cone-shaped PDA with a large aortic base was outlined. A second selective angiographic procedure was performed to functionally close the PDA by use of thrombotic coils; complete obstruction was obtained. Twenty-four hours after the procedure, the murmur disappeared. One month later, the dog was reexamined and found to be clinically normal.

Role of intraoperative cholangiography in laparoscopic cholecystectomy

The results of a policy of selective cholangiography were assessed in 400 patients undergoing laparoscopic cholecystectomy. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was performed in 81 patients (20 per cent) of whom 31 (38 per cent) showed definite or possible evidence of stones in the bile duct. Seventeen of the 400 patients underwent intraoperative cholangiography and the majority of these (12) were normal. After a minimum follow-up of 1 year, 17 patients (4 per cent) have had ERCP for suspected residual duct stones. Eight (2 per cent) of these revealed stones and all were successfully treated with sphincterotomy and duct clearance. Preoperative and postoperative ERCP was not associated with mortality or major morbidity. No major duct injury occurred and none was diagnosed within 2 years of operation. Routine intraoperative cholangiography is not a necessary part of laparoscopic cholecystectomy in the presence of an efficient and safe ERCP service.

Double-contrast barium enema and flexible sigmoidoscopy for routine colonic investigation

Over a 3-year period, all patients referred for barium enema examination had a double-contrast barium enema and flexible sigmoidoscopy performed on the same day. A total of 462 joint examinations were performed. Abnormalities were found in 193 patients by the use of barium enema, 164 patients by using sigmoidoscopy and 294 by the use of both methods of investigation. Sigmoidoscopy was superior to barium enema in the detection of polyps and inflammatory bowel disease but barium enema was more sensitive for diverticular disease. The presenting symptoms had no predictive value in distinguishing carcinoma, polyps and diverticular disease. Diverticular disease did not reduce the sensitivity of barium enema examination to polyps in the sigmoid colon. Fibreoptic sigmoidoscopy immediately before barium enema was well tolerated by patients. The investigations were complementary in the diagnosis of colonic polyps, inflammatory bowel disease and diverticular disease.

Laparoscopic cholecystectomy as a safe and effective treatment for severe acute cholecystitis

OBJECTIVE

To evaluate the feasibility and safety of laparoscopic cholecystectomy in severe acute cholecystitis.

DESIGN

Analysis of data collected prospectively from a consecutive series of 350 laparoscopic operations.

SETTING

Two general surgical units in a teaching hospital.

SUBJECTS

31 patients with a diagnosis of severe acute cholecystitis based on clinical examination, investigation results, and operative findings.

INTERVENTIONS

Initial intravenous fluids and broad spectrum antibiotics followed by laparoscopic cholecystectomy within 72 hours of presentation.

MAIN OUTCOME MEASURES

Failure to complete the operation laparoscopically, length of postoperative stay in hospital, early postoperative morbidity, interval from operation to full activity, and return to work.

RESULTS

Laparoscopic cholecystectomy was attempted in 19 patients with empyema of the gall bladder and 12 who had severe cholecystitis which failed to settle on medical management. A total of 29 operations were successfully completed with two conversions to open surgery. Two minor postoperative complications occurred, and one case of retained common bile duct stones with jaundice was treated by endoscopic retrograde cholangiopancreatography and papillotomy. Median postoperative hospital stay was two days, with return to normal activity in seven days and to work in two weeks. There were no deaths related to the operation.

CONCLUSIONS

In the presence of severe acute cholecystitis laparoscopic cholecystectomy is feasible in most patients, with minimal risk of injury to surrounding structures and considerable benefits. It is recommended that laparoscopic cholecystectomy should be attempted in these patients when appropriate surgical skill is available.

Ophthalmologic electronic imaging and data transfer

A technique has been developed that allows slit lamp images from a patient in a remote locale to be captured by a computer, with the assistance of a non-ophthalmologist, and transmitted at rapid speeds through telephone lines to an ophthalmologist for visualization of relevant clinical information. The results from this study indicate that (1) eye examinations can be performed at the remote site by non-ophthalmologists; (2) objective data can be transferred to a centralized ophthalmologist for expert interpretation; and (3) decisions can be rendered in areas where medical needs are underserved.

A comparison of low-dose maintenance treatment with enprostil against ranitidine in the prevention of duodenal ulcer recurrence

Enprostil, a prostaglandin E2 analogue, is effective in healing acute duodenal ulcer but its value in preventing recurrence, when given daily for maintenance therapy, is uncertain. In this three-centre study we compared enprostil and ranitidine maintenance therapy; the latter is known to reduce duodenal ulcer relapse rates. Patients whose duodenal ulcers had been healed by treatment with an H2-receptor antagonist were randomized to receive single-blind treatment with either 35 micrograms enprostil (n = 64) or 150 mg ranitidine (n = 64) at bedtime for periods of up to 1 year. Endoscopy was routinely performed at 3 months at one centre, and at 6 and 12 months at all three centres, or whenever ulcer symptoms recurred. Clinical assessment and laboratory investigations were performed every 3 months. Relapse, defined as recurrent ulcer with or without pain, or erosions with pain, was significantly greater in patients on enprostil, the comparative rates at 3, 6 and 12 months were: enprostil 23, 31 and 36% ranitidine 6, 12 and 17% (P = 0.013; P = 0.03 and P = 0.03, respectively). Thirty-one patients reported adverse events, the most common being headache (enprostil = 6, ranitidine = 2) and mild diarrhoea (enprostil = 6, ranitidine = 0). Four patients on enprostil were withdrawn for adverse events, although none terminated because of diarrhoea. There were no clinically significant changes in haematology or biochemistry. Enprostil may reduce duodenal ulcer relapse but at a dose of 35 micrograms nightly, it is less effective than 150 mg ranitidine nightly.

An epidemiologic investigation of forced expiratory volume at 1 second and respiratory symptoms among employees of a toluene diisocyanate production plant

Pulmonary function tests were done and compared to current and past potential exposure levels of toluene diisocyanate (TDI) for 57 TDI manufacturing workers and 89 workers not exposed to TDI or other known respiratory hazards. The average TDI plant experience was 4.1 years (standard deviation = 2.8). Routine industrial hygiene measurements have shown TDI exposure below a time-weighted average of 0.005 parts per million and a short-term exposure level of 0.02 parts per million. A certified industrial hygienist ranked department and job classification by level of potential exposure to TDI (none, low, moderate, and high). A questionnaire was administered to determine the prevalence of respiratory symptoms and smoking habits. Using backward regression analysis, cumulative pack-years of cigarette smoking and prevalence of lower respiratory symptoms were statistically significant predictors of a standardized forced expiratory volume at 1 second observed v expected difference; however, TDI exposure, whether classified as current, highest career level, cumulative, or cumulative highest-to-date, was not associated with a decline in forced expiratory volume.

Endoscopic pancreatography in cystadenoma of the pancreas

A case of mucinous cystadenoma of the tail of the pancreas is reported in which endoscopic retrograde cholangiopancreatography was used to define the surgical anatomy prior to operation. The demonstration of a normal proximal main duct allowed simple ligation of the body of the gland when the tail was excised.

Dyspepsia: incidence of a non-ulcer disease in a controlled trial of ranitidine in general practice

Patients who presented to their family doctors with previously uninvestigated dyspepsia of at least two weeks' duration were recruited into a placebo controlled trial of treatment with ranitidine (150 mg twice daily) for six weeks. All patients were examined by endoscopy before treatment, and for those with macroscopical abnormalities the examination was repeated after treatment. Of the 604 patients recruited, 559 had endoscopy, of whom 171 (30%) had no apparent abnormality. Of the 388 patients remaining, one third had two or more lesions. The high incidence of underlying disease was coupled with low accuracy in unaided clinical diagnosis. After endoscopy 496 patients with persistent symptoms (median duration six to eight weeks) were randomly allocated to treatment and then reviewed every two weeks. Complete remission of symptoms occurred in 76% of patients who were taking ranitidine and in 55% who were taking placebo (p less than 0.000004). Of those with non-ulcer dyspepsia, significantly more became symptom free taking ranitidine compared with placebo (p less than 0.002). Ranitidine healed most duodenal ulcers (80%) and gastric ulcers (90%) within four weeks. Tolerance to ranitidine was good, and the incidence of complaints was similar on placebo.

Behavioral effects of 0 and 0.05% blood alcohol in male volunteers

Five behavioral tests were evaluated to determine their sensitivity to the subtle central nervous system (CNS) depressant effects produced by ingestion of ethanol. Twenty-one adult male volunteers received 0 and 1.4 ml 100 proof vodka/kg body weight according to a "double-blind" crossover design. Behavioral tests were conducted between 15 and 65 minutes after ethanol ingestion, when blood alcohol concentrations (BAC's) were between 0.05 and 0.06%. Tests evaluated were Archimedes spiral, digit span memory, critical flicker fusion, stabilometry and tachistoscope. Multivariate analysis of variance (MANOVA) using composite scores representing the individual tests indicated that the battery as a whole was sensitive to ethanol effects. Repeated measures analysis of variance (ANOVA) on each test indicated that critical flicker fusion, stabilometry and tachistoscope contributed more to the overall sensitivity of the battery than did digit span memory and Archimedes spiral.

Validation of human behavioral tests using ethanol as a CNS depressant model

This study evaluated the sensitivity of a battery of tests proposed for use in determining the depressant effects of chemicals on human central nervous system (CNS) function. The first step in the development of such tests was to determine if the tests could detect the effects produced by a known CNS depressant, ethanol. Five behavioral tests, digit span memory, simple reaction time, tachistoscopic perception, flicker fusion and anticipation timing (velocity estimation) were evaluated to determine their sensitivity to the effects of ethanol at blood levels between 0.05-0.06%. Thirty-one adult male volunteers received 0 and 1.4 ml 100 proof vodka/kg body weight according to a double-blind crossover design. Tests were conducted before treatment and between 30 and 70 minutes after an ethanol or control drink was ingested. Multivariate analysis of variance (MANOVA), using composite scores representing the individual tests, indicated that the battery as a whole detected statistically significant ethanol effects. Repeated measures analysis of variance (ANOVA) comparing performance after drinking ethanol to control performance on each of the individual tests indicated a significant decrement in reaction time, tachistoscopic perception and anticipation timing.

Pharmacokinetics of inhaled methyl chloride (CH3Cl) in male volunteers

Six volunteers, 25-41 years of age, were exposed for 6 hr on separate days to 50 and 10 ppm of CH3Cl. Blood and expired air CH3Cl concentrations reached an apparent plateau during the first hour of the exposure and were proportional to the exposure concentration. Consistent with previous reports, the volunteers could be separated into two discrete groups based on the differences observed in their blood and expired air CH3Cl concentrations. Both groups eliminated CH3Cl rapidly once the exposure was terminated, but CH3Cl was eliminated more rapidly by those volunteers with the lower blood and expired air CH3Cl concentrations. The existence of these two groups can be explained by a twofold difference in the rate at which they metabolized CH3Cl; however, this difference is of questionable toxicological significance. Urinary excretion of the putative metabolite S-methyl cysteine was not related to the exposure; thus, it is not a valid means of monitoring occupational exposure to CH3Cl.