Clinical course and management of paclitaxel extravasation

Four case reports describing our experience with clinical course and management of paclitaxel extravasation are presented. Local reactions included swelling, mild pain, erythema, induration and hyperpigmentation, but no ulceration. Two patients were treated with cooling only while two further patients received additional hyaluronidase injections subcutaneously. The latter patients suffered longer from symptoms. Local reaction resolved within two weeks and paclitaxel treatment was continued in 3 of 4 patients without further complications. Overall, paclitaxel extravasation induced only mild soft tissue reaction and cooling should be considered standard treatment.

Comparison of platelet-rich plasma and VEGF-transfected mesenchymal stem cells on vascularization and bone formation in a critical-size bone defect

Both platelet-rich plasma (PRP) and vascular endothelial growth factor (VEGF) can promote regeneration. The aim of this study was to compare the effects of these two elements on bone formation and vascularization in combination with bone marrow stromal cells (BMSC) in a critical-size bone defect in rabbits. The critical-size defects of the radius were filled with: (1) a calcium-deficient hydroxyapatite (CDHA) scaffold + phVEGF(165)-transfected BMSC (VEGF group), (2) CDHA and PRP, or (3) CDHA, autogenous BMSC, and PRP. As controls served: (4) the CDHA scaffold alone and (5) the CDHA scaffold and autogenous BMSC. The volume of new bone was measured by means of micro-CT scans, and vascularization was assessed in histology after 16 weeks. Bone formation was higher in the PRP + CDHA, BMSC + CDHA, and PRP + BMSC + CDHA groups than in the VEGF group (p < 0.05). VEGF transfection significantly promoted vascularization of the scaffolds in contrast to BMSC and PRP (p < 0.05), but was similar to the result of the CDHA + PRP + BMSC group. The results show that VEGF-transfected BMSC as well as the combination of PRP and BMSC improve vascularization, but bone healing was better with the combination of BMSC and PRP than with VEGF-transfected BMSC. Expression of VEGF in BMSC as a single growth factor does not seem to be as effective for bone formation as expanded BMSC alone or PRP which contains a mixture of growth factors.

Hereditary polyneuropathy in the Alaskan Malamute

OBJECTIVE

To prove the hypothesis that a polyneuropathy in Alaskan Malamutes has a genetic background.

MATERIAL AND METHODS

Pedigrees of 131 related Alaskan Malamutes were included in the current study. Neurological examination, electrodiagnosis as well as muscle and nerve biopsies could be performed in 10 dogs. Information about the disease status of the other 121 Alaskan Malamutes were supplied by referring veterinarians, breeders and owners. Segregation analysis using four different models (monogenic, polygenic, mixed monogenic-polygenic and the phenotypic model) was performed on 71 dogs to test the different mechanisms of genetic transmission.

RESULTS

In seven clinically affected dogs abnormal electromyographic findings and reduced nerve conduction velocity were detected. Suspected diagnosis of polyneuropathy was confirmed by nerve biopsy results, characterized by axonal degeneration and hypomyelination. Muscle specimens revealed signs of neurogenic myopathy. Three related clinically normal Alaskan Malamutes also displayed moderate neuromuscular changes in histopathology. In the segregation analysis the polygenic model proved as best suitable to explain the observed segregation pattern among all other models tested.

CONCLUSION

The current study could demonstrate that polyneuropathy in Alaskan Malamutes is a hereditary disease with variable phenotypic expression ranging from severely affected to subclinical forms, which has to be considered in future gene analysis studies.

The influence of bevacizumab on platelet function

Systemic treatment with bevacizumab is associated with increased rates of arterial and venous thromboembolism and haemorrhage. In order to investigate the pathophysiological mechanism involved, platelet adhesive and aggregatory functions were tested with a platelet function analyser (PFA-100®) in an in vitro study and in a longitudinal clinical observation study. For the in vitro study, blood from ten healthy volunteers was incubated with different concentrations of bevacizumab (0-1000 μg/ml plasma) and vascular endothelial growth factor (0-500 μg/ml). In the clinical observation study, PFA-100® closure times (CTs) and soluble P-selectin (sP-selectin) serum levels as a serological marker of platelet activation were assessed in 20 patients with metastatic cancer who were treated with bevacizumab in addition to cytotoxic chemotherapy. No significant changes of PFA-100® CTs were observed in the in vitro study. In the clinical observation study, mean PFA-100® CTs after treatment with bevacizumab were unchanged. sP-selectin was decreased after bevacizumab infusion by 18% (p = 0.045), which could suggest an inhibitory action on platelets. Our data do not support the view that increased platelet activation or increased platelet adhesiveness and aggregation by bevacizumab are relevant mechanisms for thrombus formation in clinical practice.

[Lameness and osteoarthritis development following Tibial Plateau Leveling Osteotomy (TPLO) and potential prognostic predictors. A long-term retrospective study]

OBJECTIVE

Evaluation of lameness and osteoarthritis (OA) progression following Tibial Plateau Leveling Osteotomy (TPLO) in dogs with naturally-occurring rupture of the cranial cruciate ligament (CCL) and investigation of factors with potential influence on long-term outcome.

MATERIAL AND METHODS

In a retrospective clinical study medical records of 119 client-owned dogs (135 operated stifle joints) and corresponding client-questionnaires were reviewed, collecting data on radiologic and surgery results, course of surgery and complications. In a check-up, orthopaedic examination and stifle radiographs were performed to assess status quo of OA, lameness, and progression of OA.

RESULTS

58 dogs (66 stifle joints) could be examined clinically and radiologically, whereas 61 dogs (69 stifle joints) were re-checked by client-questionnaire only. Up to 6.8 years after TPLO surgery, in 90.4% of all cases lameness results were judged "excellent" (n=84) or "good" (n=38). In the long term, there was a moderate but significant progression of OA following TPLO surgery. Patients with totally ruptured CCL were significantly more likely to have meniscal injury than dogs with partially ruptured CCL. Dogs with partial meniscectomy had a significantly higher rate of "excellent" long-term clinical results and less frequently showed progression of OA compared to those having the meniscus released or left untouched. The overall complication rate was 22.2% (n=30), with the type of complication having no influence on the long-term clinical outcome.

CONCLUSIONS AND CLINICAL RELEVANCE

Regarding lameness, the long-term outcome following TPLO is very satisfying. Early surgical treatment of CCL rupture using TPLO can help to decrease the likelihood of OA progression. Partial medial meniscectomy may help to avoid repeated surgery due to subsequent meniscal injury without having a negative impact on long-term functional outcome or the progression of OA in the affected joint. Neither long-term clinical results, especially regarding lameness, nor OA were impaired by previous surgery prior to TPLO or the occurrence of complications associated with TPLO surgery.

[Fractures and luxations in small mammals]

Most traumata in small mammals occur at home. Diagnosis and therapy can be compared with that in the dog and cat, but species-specific differences have to be considered. For fracture treatment a butterfly-cast can be sufficient for stabilization in special cases. In most cases satisfying results can be obtained with a "tie-in-fixator" treatment. Dislocations of the elbow joint are treated by reduction or stabilization through suture techniques or temporary arthrodesis.

Spontaneous pneumothorax during chemotherapy: a case report

BACKGROUND

Spontaneous pneumothorax (SP) associated with malignant disease is relatively infrequent but has important diagnostic and therapeutic implications.

CASE REPORT

We describe a case of SP that occurred during chemotherapy with ifosfamide and doxorubicin in a patient with an advanced pleomorphic sarcoma. The pneumothorax developed secondary to the rapid regression of peripheral pulmonary metastases presumably resulting in bronchopleural fistula formation. After treatment with chest tube drainage, the patient recovered and chemotherapy could be continued without further complications.

DISCUSSION

We discuss different pathophysiological mechanisms and the clinical context of SP in sarcoma patients and give an overview of the literature and different treatment options.

Primary manifestation of small lymphocytic lymphoma in the prostate

BACKGROUND

Infiltration of non-haematopoietic organs by small lymphocytic lymphoma/chronic lymphocytic leukaemia (SLL/CLL) is not unusual in late-stage disease and thus quite frequently encountered in post-mortem examinations. However, primary manifestation of SLL/CLL in the prostate is rarely diagnosed.

PATIENTS AND METHODS

We report two cases of primary prostatic SLL/CLL, in one case in combination with prostate carcinoma, and discuss diagnostic pitfalls, pathophysiological mechanisms and therapeutic management, together with an overview of the literature.

CONCLUSIONS

Lymphocytic infiltration of the prostate associated with obstructive symptoms is rare but can already occur in very early disease. Microscopically, SLL/CLL infiltration can be distinguished from chronic prostatitis by its pattern of infiltration and by immunohistochemistry. As the incidence of both SLL/CLL and prostatic carcinoma increases with age, composite tumours might occur more often in the future.

Bevacizumab and pegylated liposomal doxorubicin as first-line therapy for locally recurrent or metastatic breast cancer: A multicenter, single-arm phase II trial of the Swiss Group for Clinical Cancer Research (SAKK)

1030

Background: Bevacizumab in combination with taxanes has become a standard first-line treatment of advanced breast cancer in some countries, but there is no information on its use in combination with pegylated lipsomal doxorubicin in metastatic breast cancer. Therefore, we performed a multicenter, single-arm phase II trial to evaluate the toxicity and efficacy of pegylated liposomal doxorubicin (PLD) and bevacizumab (B) as first-line treatment in advanced breast cancer. Methods: PLD at a dose of 20 mg/m2 and B at 10 mg/kg were infused on days 1 and 15 of each 4-week cycle for a maximum of 6 cycles. Thereafter, B monotherapy was continued at the same dose until progression or toxicity. Primary endpoint was the occurrence of specific toxic events known to strongly interfere with quality of life, i.e., severe cardiac toxicity, any grade 4/5 toxicity, and selected grade 3 nonhematological toxicities (hand-foot-syndrome, cognitive disturbance, CNS hemorrhage, and mucositis/stomatitis). Secondary endpoints included overall response, progression free survival (PFS), time to treatment failure, and duration of response. Eligibility criteria included documentation of metastatic or inoperable breast cancer; measurable disease according to RECIST; erbB2-negativity; LVEF of ≥ 55%; WHO performance status 0 or 1. The study used a Herndon's two-stage design with 14 and 29 patients for stages 1 and 2, respectively. The promising rate of primary toxicity was <15% and the uninteresting rate >33%. The type I error probability was 5% and the power 80%. Results: The trial had to be stopped prematurely because of toxicity after the enrollment of 41 evaluable patients. Among these patients, 16 (39%) had grade 3 hand-foot syndrome, 1 grade 3 mucositis and 1 grade 4 cardiac toxicity. Thus, a total of 18/41 (44%, exact 95% c.i. 28–60%) of all patients had a primary toxicity. Best overall response rate was 23.3% (exact 95% c.i. 12–39%), median PFS was 7.5 months (95% c.i. 4.6–8.1 months). Conclusions: The combination of 2-weekly PLD and B in advanced breast cancer is surprisingly toxic and only modestly active and should not be further investigated.

[Table: see text]

[Course of Osteodystrophia fibrosa generalisata in a satin guinea pig]

In a 14 months old satin guinea pig Osteodystrophia fibrosa generalisata was diagnosed by clinical and x-ray examination. The guinea pig was treated palliatively with Meloxicam and Natriumrisedronate as well as periodic dental treatment. At the age of 3 years and 10 months the guinea pig died, but necropsy was denied by the owner.

A microbiological survey of selected Alberta-grown fresh produce from farmers' markets in Alberta, Canada

Previously there was no available information on the levels of indicator bacteria and the prevalence of pathogens in fresh produce grown in Alberta, Canada. Baseline information on the occurrence and levels of Escherichia coli and the prevalence of foodborne pathogens in selected produce items available to consumers from farmers' and public markets in two large urban centers and surrounding areas in Alberta was obtained. A total of 10 large markets with between 1 and 12 produce vendors and 26 small markets with between 1 and 6 produce vendors were sampled from 21 June to 7 October 2007. Lettuce (128 samples), spinach (59 samples), tomatoes (120 samples), carrots (206 samples), green onions (129 samples), and strawberries (31 samples) were analyzed for E. coli, Salmonella, E. coli O157:H7, and Campylobacter spp. Lettuce, spinach, green onion, and strawberry samples were also tested for the presence of Cryptosporidium spp. Information on whether produce was grown using organic or conventional practices was obtained from the produce vendors. E. coli was isolated from 8.2% of the samples that included lettuce, spinach, carrots, and green onions. The bacterial counts ranged from <0.48 to >3.04 Log most probable number per g. E. coli was not isolated from tomatoes or strawberries. The percentage of positive samples ranged from 4.4% for carrots to 27.1% for spinach. Salmonella, E. coli O157:H7, and Campylobacter spp. were not isolated from any of the samples. Cryptosporidium was identified by PCR in one sample of spinach (0.6% of the samples).

Improved intra-operative reduction control using a three-dimensional mobile image intensifier - a proximal tibia cadaver study

This study aimed to analyse whether the precision of a three-dimensional mobile image intensifier (ISO-C 3D) differs from conventional two-dimensional fluoroscopy and high resolution CT scan in a fracture model of the proximal tibia. A depression fracture of the medial plateau (AO/OTA 41-B2.3) was created in 12 formalin-fixed, human cadaver knees. The cartilage of the depression could be positioned above (+1mm, +2mm), below (-1mm, -2mm), or in line with the joint surface. Fluoroscopy, computed tomography (CT) scans, and ISO-C 3D scans (four different protocols: 100 images, 66 images, 50 images, and 33 images) were done for each fracture level. Three independent observers assessed each imaging set. The difference between the estimated reduction and the real reduction was used for statistical analysis. Our hypothesis was that no differences in the precision exist between the imaging techniques (p<0.05). The conventional image intensifier group (0.7 mm+/-0.67) showed significantly higher deviations than the CT group (0.3 mm+/-0.43; p<0.001) and significantly higher deviations than all ISO-C 3D groups (0.4-0.5 mm; p<0.001). Of the ISO-C 3D groups, only the scan protocol with the lowest number of images (0.5 mm+/-0.51) showed significantly lower precision than the CT group (p<0.001). It was concluded that the three-dimensional mobile image intensifier showed higher precision in reduction assessment in a fracture model of the tibial plateau compared to fluoroscopy. High resolution CT scans should remain the standard for post-operative assessment of reduction outside the operating theatre.

Comparison of two beta-tricalcium phosphate composite grafts used for reconstruction of mandibular critical size bone defects

OBJECTIVE

The aim was to compare osseointegration of blood perfused beta-tricalcium phosphate cylinders (beta-TCPB) with similar composites that were additionally loaded with cancellous bone and bone marrow (beta-TCPB/BM/CB) for mandibular reconstruction.

METHODS

Twelve German Black-Headed sheep with an average weight of 72.5 +/- 10 kg underwent segmental resection of the right hemi-mandible. The animals that were assigned to group A (n = 6) were reconstructed using beta-TCPB while the sheep that were assigned to group B received beta-TCPB/BM/CB grafts. Tissue quality was histologically assessed and bone-, scaffold-, cartilage- and fibrous-tissue area were estimated using semiautomated histomorphometrical software.

RESULTS

Composite grafts that were loaded with bone marrow and cancellous bone (beta-TCPB/BM/CB) exhibited significant (p<0.01) higher amounts of bone formation than beta-TCPB. The patients that were assigned to group B achieved defect union and a high grade of bone maturation. Residual ceramic remnants were rare and disconnected. Bone maturity within group A was inferior and none of the specimens showed defect union. The defect centre was still occupied by a ceramic core.

CLINICAL SIGNIFICANCE

Bone and bone marrow augmented beta-tricalcium phosphate composites may qualify as a promising alternative to autograft bone for mandibular reconstruction in human and veterinary medicine.

[Laparoscopy in the management of endometrial cancer]

Recent advance in laparoscopy have changed the surgical approach of endometrial cancer patients. The Swissendos Center, Fribourg, in collaboration with AGO (Groupe de travail pour la gynécologie oncologique) and AGE (groupe de travail pour la gynécologie endoscopique) have established a consensus based on the available evidence for the use of laparoscopy in the management of patients with endometrial cancer The main objective was to define Swiss clinical practice guidelines appropriate to the country and consistent with the needs of the physicians.

Prolonged foetal retention in a bitch resulting in trichogranulomatuous panmetritis and re-establishment of fertility after unilateral ovariohysterectomy

This case report describes the clinical course, the diagnostic and therapeutic management as well as histopathological findings in a case of foetal retention for about 5 months in a 5-year-old Boxer. Clinical symptoms included mucosanguinous vaginal discharge and a firm ovoid mass of about duck egg size palpable in mid abdomen. Sonographic examination was not suitable to visualize uterine contents, while radiography revealed a conglomeration of foetal bones focally visible in the right uterine horn, which was surgically removed together with the ipsilateral ovary in order to maintain the fertility of the bitch. After lancing the uterine wall the osseous skeleton as well as parts of hairy skin and muscles of the foetus attaching the uterine wall were detected. Histologically a unilateral necrotizing panmetritis with almost complete destruction of the endometrial structures was diagnosed. Furthermore, the endometrium, the myometrium as well as the serosa revealed a severe trichogranulomatuous inflammation with numerous foetal hairs visible within the inflammatory alterations. After treatment of the bitch with prostaglandin F(2alpha) and an antibiotic agent she became pregnant in the second heat after surgery and gave birth to two healthy puppies. This is the first report on foetal retention for several months followed by unilateral ovariohysterectomy with subsequent recovery of fertility. Furthermore, this case report describes for the first time the histomorphological diagnosis of a unilateral trichogranulomatuous panmetritis in a bitch.

Influence of acute alcohol exposure on hemorheological parameters and platelet function in vivo and in vitro

We have analysed the influence of acute alcohol exposure in vivo and in vitro on blood flow properties and platelet function. 12 healthy male volunteers drank either 4.36 ml red wine/kg body weight (=0.5 g ethanol/kg) or water at 06.00 p.m. under fasting conditions. Blood was drawn immediately before, and 1, 2, 4 and 13 h after alcohol ingestion. Alcohol had a detectable osmotic effect on erythrocytes; the mean cellular volume (MCV) was significantly smaller 1-4 h after ingestion. Whole blood viscosity remained unaffected, but blood viscosity at a standardized Hct of 45% measured at a high shear rate (94.5 s(-1)) was increased 2 h after wine ingestion. In the morning, 13 h after wine drinking, platelet aggregation measured with a platelet function analyser PFA-100 was increased to a greater extent than after water drinking. In vitro, no effect was seen when blood was incubated with 0, 12.5, 25, 50 and 100 mmol/l ethanol for 1 h at 37 degrees C. We conclude that an acute exposure to alcohol has only modest effects on hemorheological parameters and platelet aggregation in vivo and no effect in vitro, which suggests that other factors must be involved in both beneficial and harmful effects of wine drinking.

[Vocational integration after a two-year retraining measure in vocational retraining centres--a prognostic model]

BACKGROUND

Vocational rehabilitation aims at occupational reintegration of the clients. This article focuses on several key results of an evaluation study on rehabilitative vocational training programmes. A central research goal was to identify prognostic factors for successful vocational integration.

METHOD

Three vocational retraining centres (Berufsförderungswerke) participated in this cohort study with five waves of measurement. Data gathering on process and outcome quality of the two-year training programmes was based on client-surveys (questionnaires). A prognostic model for occupational integration one year after the training measure was developed, based on questionnaire data gathered at the beginning of the training courses.

RESULTS

One year after completion of their training 55% of the participants had returned to a job (dependent or self-employed). The logistic regression model for prognosis of return to work showed six relevant variables, and occupational integration as well as nonintegration 12 months after training could be predicted in 77%. Regional unemployment rates revealed to be the most important predictive variable for job reintegration. Other significant variables were: control beliefs, educational level, pain, perceived social support, and occupational field. Neither marital status nor level of disability (GdB) proved predictive for return to work. The variables age and gender were significant only in the univariate analysis.

DISCUSSION AND CONCLUSION

A set of variables could be identified as predictive for return to work after a two-year vocational training measure. Some variables, such as control beliefs or perceived social support, may indicate possibilities for specific supportive interventions.

Morphological and Immunohistochemical Characterization of Spontaneous Mammary Tumours in European Hedgehogs ( Erinaceus europaeus )

Mammary tumour samples (11 surgical and five post-mortem) from 16 adult European hedgehogs submitted between 1980 and 2004 were examined. Histologically, the tumours were classified as simple tubulo-papillary carcinomas with local invasive growth. In six cases, tumour cell emboli were present in blood vessels or lymphatic vessels, or both. However, metastasis to regional lymph nodes was found only in one hedgehog. Malignant neoplastic epithelial cells were immunolabelled by antibodies specific for various cytokeratins (CKs), including CK1-8, 10, 13-16, 19 and 20. CK expression did not differ from that in normal mammary gland tissue. CK20 was expressed in the mammary tissue of hedgehogs, in contrast to that of dogs and cats; CK7 immunolabelling, however, which commonly occurs in mammary epithelial cells, was negative. CK20 expression, together with the lack of CK7 as determined by a protein-specific antibody, represented an important difference from the CK profile shown by mammary epithelial cells of other mammalian species, including the dog and cat.