Anatomical classification of feline congenital extrahepatic portosystemic shunts based on CT angiography: A SVSTS and VIRIES multi-institutional study in 231 cats

The prevalence of anatomical-based subtypes of feline congenital extrahepatic portosystemic shunts (EHPSS) has not been completely elucidated. The goal of this study was to use CT angiography to create an anatomical-based nomenclature system for feline congenital EHPSS. Additionally, subjective portal perfusion scores were generated to determine if intrinsic portal vein development was associated with different shunt conformations or patient age at the time of CT. The SVSTS and VIRIES list services were used to recruit cases. Data collected included patient DOB, gender, breed, weight, CT date, and reported diagnosis. Shunts were classified based upon (1) the shunt portal vessel(s) of origin, (2) the shunt systemic vessel(s) of insertion, and (3) any substantial portal vessels contributing to the shunt. Additionally, hepatic portal perfusion was subjectively scored between 1 (poor/none) and 5 (good/normal) based on the caliber of the intrahepatic PVs. A total of 264 CT scans were submitted from 29 institutions. Due to exclusion criteria, 33 (13%) were removed, leaving 231 CT scans to be included. Twenty-five different EHPSS anatomies were identified with five classifications accounting for 78% of all shunts (LGP [53%], LGC-post [11%], LCG [7%], LGC-pre [4%], and PC [4%]). Shunt origin involved the left gastric vein in 75% of the described classifications. Significant differences were identified among the five most common shunt types with respect to age at the time of CT scan (P = .002), breed (P < .001), and subjective portal perfusion score (P < .001). This refined anatomical classification system for feline EHPSS may enable improved understanding, treatment comparisons, and outcome prediction for cats with these anomalies.

Transpalatal reconstruction and stenting for treatment of choanal atresia and nasopharyngeal stenosis in a dog

CASE DESCRIPTION

A 3-year-old 17.5-kg (38.5-lb) mixed-breed dog was referred for evaluation because of nasal discharge, sneezing, and signs of nasal congestion of approximately 9 months' duration. A diagnosis of nasopharyngeal stenosis (NPS) was made prior to referral.

CLINICAL FINDINGS

Sneezing, bilateral mucopurulent nasal discharge, reduced nasal airflow, stertor, and increased inspiratory effort were noted on physical examination. Results of serum biochemical analysis were within respective reference ranges. Review of CT images of the skull revealed findings consistent with severe bilateral partial osseous choanal atresia and NPS. Retrograde rhinoscopy confirmed membranous NPS.

TREATMENT AND OUTCOME

A ventral rhinotomy was performed; communication between the pharynx and nasal passageway was reestablished by surgical debridement of the caudal border of the palatine bone and vomerine crest and groove, followed by dissection of the membranous NPS and reconstruction of the caudal part of the nasopharynx. A covered nasopharyngeal stent was placed in the newly established nasopharynx. The dog recovered uneventfully but was presented 3 weeks later with recurrent signs; diagnostic findings were consistent with stenosis rostral to the stent. The stenosis was treated with balloon dilation, and a second covered stent was placed rostral to and overlapping the first stent, spanning the stenotic region. Eleven months after this procedure, the dog was doing well.

CLINICAL RELEVANCE

Results for this patient suggested that ventral rhinotomy and covered nasopharyngeal stent placement can be used successfully for the management of osseous choanal atresia in dogs; however, careful attention to preoperative planning and potential complications is necessary.

An Interdisciplinary Approach to Surgical Skills Training Decreases Programmatic Costs

BACKGROUND

Surgical resident duty hour limitations have necessitated operative skill training outside of the operating room. Although wet-lab skills training is ideal, materials and human resource requirements make wet labs-utilizing biologic samples cost prohibitive for many residency programs. To resolve this problem, our general surgery residency program collaborated with the Institution's School of Veterinary Medicine Surgery Residency program to pilot a cost-effective interdisciplinary surgical skills curriculum.

MATERIALS AND METHODS

The general surgery residency program manager and program director initiated a collaboration with the Veterinary Surgery Residency. Postgraduate year (PGY) 2 general surgery residents and PGY 1-3 veterinary surgery residents participated in monthly joint surgical skills practice sessions. A novel interdisciplinary surgical skills curriculum was implemented that incorporated skills beneficial to both sets of trainees utilizing donated canine cadavers.

RESULTS

A total of nine joint skills sessions were conducted for nine general surgery residents and five veterinary surgery residents. A cost analysis was conducted for a surgical skills curriculum servicing both programs independently and compared to the actual costs of the collaborative curriculum. The cost analysis estimated total savings generated by the collaborative to be $27,323.79. Review of initial feedback from trainees suggest that skill sessions reinforce knowledge, and that the collaborative skills sessions were an enjoyable and valuable learning activity.

CONCLUSIONS

The skills curriculum collaborative has proven to be a cost-effective and high quality interdisciplinary pedagogic tool. The partnership allowed for mutually beneficial resource sharing and allowed for the initiation of a surgical skills wet lab that had previously been unavailable to both groups.

A Pilot Study of Acupuncture for Tension Headache, Using a Novel Placebo

Tension headache is common, and treatment with acupuncture is frequently recommended, although the evidence of its effectiveness is contradictory. This small, randomised, controlled trial was designed as a pilot to test procedures in preparation for a multi-centre trial investigating the effect of acupuncture as a treatment for tension headache. Ten volunteers suffering from episodic, tension-type headache were recruited by local newspaper articles. Patients were randomised to receive either brief needling to tender areas or selected traditional points (Group A), or pressure from a cocktail stick supported within a guide tube to defined, non-tender and non-acupuncture areas (Group B). The patients’ view of the treatment sites was obstructed so that no indication could be gained as to which form of treatment was being given.

Throughout the period of the trial, duration, frequency and intensity of headaches were recorded, from which the mean weekly headache index was calculated. There was no difference between the changes in weekly headache index in the two groups, comparing scores before and after treatment. However, Group A experienced a considerably higher number of headache-free weeks than Group B. The credibility of the two procedures was tested using a standard credibility questionnaire and a “final verdict”. One subject in Group B concluded that she had not received genuine acupuncture, but overall there was no statistical difference between the credibility of treatment in the two groups.

Seroprevalence of human toxocariasis, Jamaica

Seroprevalence of human toxocariasis was studied, based on 1544 samples selected from a total of 3524 submitted to the University of the West Indies in Kingston, Jamaica for diagnosis of dengue during an epidemic in 2010. The prevalence of anti-Toxocara IgG using the CELISA® (Cellabs) ELISA was 21.2% and males (24.4%) were significantly more likely to be exposed than females (17.5%) [χ² =10.4; p=0.001]. No association was foundbetween exposure to Toxocara and area of residence (rural vs. urban) [χ² =0.835; p = 0.409]. Prevalence of infection peaked in adolescents (10-19 years-old) and declined thereafter although a rise in prevalence was seen in older age classes. There was a high prevalence of toxocariasis in Jamaica with significant exposure among school age children with no predilection to either sex. The study will inform future work on elucidating the public health and clinical significance of toxocariasis in Jamaica.

Surgical Management of Ear Diseases in Rabbits

Otitis externa and media are frequently diagnosed disorders in rabbits and are particularly common in lop-eared breeds because of the specific anatomy of the ear canal. Medical management for otitis externa and media often provides only a temporary improvement in clinical signs. Surgery by means of partial or total ear canal ablation (PECA or TECA) combined with lateral bulla osteotomy (LBO) represents a feasible approach that is well tolerated and provides a good clinical outcome. Short-term complications associated with PECA/TECA-LBO include facial nerve paralysis and vestibular disease.

Randomized trial comparing cryoablation and external beam radiotherapy for T2C-T3B prostate cancer

The objective was to evaluate the relative efficacy of cryoablation (CRYO) versus external beam radiation (EBRT) for clinically locally advanced prostate cancer in a randomized clinical trial. Patients with histologically proven, clinically staged as T2C, T3A or T3B disease were randomized with 6 months of perioperative hormone therapy to one of the two procedures. Owing largely to a shift in practice to longer term adjuvant hormonal therapy and higher doses of radiation for T3 disease, only 64 out of the planned 150 patients were accrued. Twenty-one of 33 (64%) in the CRYO group and 14 of 31 (45%) in the EBRT-treated group who had met the ASTRO definition of failure were also classified as treatment failure. The mean biochemical disease-free survival (bDFS) was 41 months for the EBRT group compared to 28 months for the CRYO group. The 4-year bDFS for EBRT and CRYO groups were 47 and 13%, respectively. Disease-specific survival (DSS) and overall survival (OS) for both groups were very similar. Serious complications were uncommon in either group. EBRT patients exhibited gastrointestinal (GI) adverse effects more frequently. Taking into account the relative deficiency in numbers and the original trial design, this prospective randomized trial indicated that the results of CRYO were less favorable compared to those of EBRT, and was suboptimal primary therapy in locally advanced prostate cancer.

Joint wavelet transform correlation with separated target and reference planes

In recent years, we realize the usefulness of feature extraction for optical correlator and hereby, we investigate the capability of Laplace operator in feature extraction of multiple targets. The first-order terms and the false alarm terms in the correlation output would be removed using electronic power spectrum subtraction technique. Most importantly, the entire magneto-optic SLM is completely utilized for displaying only targets in the input scene. A new cost efficient hardware implementation is proposed and aforementioned result of the proposed system is evaluated through computer simulation.

What is the best way of assessing outcome after total knee replacement?

Variable definitions of outcome have been used in the past to assess the results after total joint replacement surgery. These differ in their approach to the measurement of outcome but all must be valid (they measure what they are designed to measure), reliable (they consistently produce the same score), and responsive (able to detect changes that may occur during a period). Responsiveness is crucial to distinguish those patients who benefit from a procedure from those who do not, and a more responsive test will theoretically be able to identify more subtle changes in patient status. The responsiveness of 6 different scoring systems was compared. The results are based on a cohort of 71 patients undergoing total knee arthroplasty in a 7-month period. Responsiveness was determined by performing a paired t test among each patient's scores at 0, 3, and 6 months. The size of the resulting t value represented the comparative responsiveness of the 6 tests. The highest value achieved was with the Western Ontario and McMaster Universities osteoarthritis index and the Knee Society clinical rating scale. The worst scores were achieved by Short Form-36 and time trade off, a utility method of measurement. If small differences between groups of patients are to be shown, measures of outcome that are more responsive to patient change should be used.

Resurfacing versus not resurfacing the patella during total knee replacement

One hundred patients with osteoarthritic knees were randomized either to have their patella resurfaced or not resurfaced using the same total knee replacement. These patients were assessed preoperatively and a minimum 2 years postoperatively using disease-specific (Knee Society Clinical Rating System) and functional capacity (30 second stair climbing and knee flexor and extensor torques) outcome measures. Two patients in the not resurfaced group required reoperation because of anterior knee pain. At 2 years' followup, the not resurfaced group had significantly less pain and better knee flexor torques than did the resurfaced group, whereas the results of the Knee Society Function Scores, 30 second stair climbing, and knee extensor torques were similar. These results suggest that longer-term followup is required, but that one should keep an open mind regarding patellar resurfacing during total knee replacement.

Dental patients' perceptions in a multiethnic environment

Ethnic relations in multicultural metropolitan areas such as Los Angeles are extremely complex and are probably reflected, at least in part, in the relations between dental providers and their patients. The goals of this study were to determine whether dental services provided by providers of a different ethnic group and whether there was a direct relation between the level of patient anxiety and the level of preference for providers of the same ethnicity. Patients at the University of Southern California School of Dentistry were surveyed using a 29-item questionnaire. The survey included questions concerning preference for their provider's ethnicity and gender, dental anxiety, dental satisfaction, dental health, and socioeconomic status. The study focused on the four most common groups of patients at USCSD: Asians, Blacks, Caucasians and Hispanics, and their perceptions with regard to the dental providers of five potential ethnic backgrounds: Asian, Black, Caucasians, Hispanics and Middle Eastern. The majority of patients in all ethnic groups reported no preference for the ethnicity of their provider listed their own ethnicity. Moreover, the recorded preference levels for providers of the own ethnicity in the Hispanic group were consistently higher in correlation with higher dental anxiety, lower satisfaction with dental treatment, and poorer dental health. Our study suggests that ethnic relations are a significant factor in the dental office in Southern California.

Vaccination against hepatitis A for travellers. All relevant costs and consequences should be measured

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Diaphragmatic weakness in hereditary motor and sensory neuropathy

Six patients severely affected by hereditary motor and sensory neuropathy (HMSN), four type I and two type II, had clinical evidence of diaphragmatic weakness. One presented with cardiorespiratory failure secondary to nocturnal hypoventilation, and three others were unable to lie flat because of dyspnoea. Diaphragmatic paralysis should be considered as a cause of respiratory or cardiac failure in cases of HMSN.

An outbreak of waterborne cryptosporidiosis caused by post-treatment contamination

An outbreak of waterborne cryptosporidiosis affecting 27 persons, diagnosed stool positive, occurred in Ayrshire in April 1988. Twenty-one in 27 confirmed cases required some form of fluid replacement therapy. Local general practitioners indicated a two- to fivefold increase in diarrhoeal disease during the outbreak, and following enquiries made by Environmental Health Officers it became apparent that many hundreds of people had suffered a diarrhoeal illness at that time. Cryptosporidium spp. oocysts were detected in the treated chlorinated water supply system, in the absence of faecal bacterial indicators. Oocyst contamination of a break-pressure tank containing final water for distribution was the cause of this waterborne outbreak. An irregular seepage of oocyst-containing water, which increased during heavy rains, was the cause of the break-pressure tank contamination, rather than a failure of the water-treatment processes. The waterborne route should be considered when clusters of cryptosporidiosis-associated with potable water occur. Waterborne cryptosporidiosis can occur in the absence of other faecal indicators of contamination.

Analysis of the pull-out strength of screws and pegs used to secure tibial components following total knee arthroplasty

The purpose of this study was to compare the pull-out forces of 3.8-mm and 6.5-mm diameter cancellous screws and a round peg 10 mm in diameter, implanted in bovine vertebral cancellous bone and two different grades of polyurethane. The relationships between the pull-out forces and the properties of the material into which they were inserted were also examined. For the same depth of insertion, the pull-out force of a 6.5-mm diameter screw was two times larger than that of a 3.8-mm diameter screw. Despite its smaller diameter, a 6.5-mm diameter screw demonstrated a pull-out force 13.6% greater than that of an optimally press-fitted 10-mm diameter round peg when both were inserted to the same depth; however, optimal compression for the peg was strongly dependent upon the size of predrilling and the modulus of elasticity of the material into which the peg was inserted. The pull-out force of a cancellous screw has a linear relationship with the shear strength of the material into which it is inserted. The pull-out force of a peg exhibits a linear relationship with the modulus of elasticity of the material into which it is inserted.

Fatal outcome of echovirus 7 infection

A 9-month-old boy died of a disseminated echovirus 7 (E7) infection with virus being cultured from his liver and spleen. His hepatic failure was complicated by candidiasis and marrow hypoplasia and aggravated by a possible immune deficiency.

Listeriosis in Ayrshire 1965-85

Twelve cases of listeriosis are described. Nine patients had meningitis, two primary listerial bacteraemia and one had bacteraemia from a focus of infection in the genito-urinary tract. Clinical presentation and treatment are described.

A new peptide boronic acid inhibitor of elastase-induced lung injury in hamsters

A highly effective, reversible elastase inhibitor, MeOSuc-Ala-Ala-Pro-boroVal-OH, was tested for its ability to prevent emphysema induced by intratracheally administered elastase in hamsters. Anesthetized hamsters were given elastase intratracheally with or without the inhibitor or were given elastase intratracheally and the inhibitor intraperitoneally. Two weeks after administration, lungs were removed, and static air pressure volume curves were performed followed by intratracheal fixation and morphometric determination of mean linear intercepts. The results indicate significant preservation of structure and function whether the inhibitor is given intratracheally or intraperitoneally and suggest that this inhibitor may be useful in controlling diseases arising from aberrant proteolysis by elastolytic enzymes.

Effects of dosage and timing of administration of a peptide boronic acid inhibitor on lung mechanics and morphometrics in elastase-induced emphysema in hamsters

The peptide boronic acid, MeOSuc-Ala-Ala-Pro-boroVal-pinacol (AAPbV), is an effective inhibitor of both pancreatic and leukocyte elastase. Initial work showed that AAPbV diminishes the effect of emphysema induced by pancreatic elastase. This initial work has been expanded to show that AAPbV provides a high degree of protection against elastase-induced increases in lung volume and mean linear intercept when given intratracheally at 200 mg/kg either 15 min before, simultaneous with, or 15 min after instilling elastase. Intraperitoneal administration, although less effective, is dose dependent and dependent on the time of treatment. We conclude that a reversible protease inhibitor can be used to prevent aberrant proteolysis in vivo.

Leg ulcer infection with an erythromycin-resistant Streptococcus pyogenes

The isolation of an erythromycin-resistant Streptococcus pyogenes from a leg ulcer is reported and its implications for antibiotic therapy discussed.

Cardiac tamponade due to Lancefield group A beta haemolytic streptococcal pericarditis

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Treatment of Parkinson's disease

Levodopa is widely regarded as the treatment of choice in Parkinson's disease although complications gradually emerge during long-term therapy. The addition of adjuvants may be worthwhile, but it must be recognized that drug therapy offers incomplete and diminished symptom relief.

The performance of circumaural hearing protectors by dosimetry

The performance of earmuffs in the actual working environment was studied with two modified dosimeters. It was found that personal hearing protection, at least with earmuffs, is a potentially adequate method of protection against noise-induced hearing loss in most industrial working situations. Most of the problems involving the use of hearing protectors in a hearing conservation program can be overcome by education and proper fitting.

Compartmental pressure measurements: an experimental investigation using the slit catheter

A new catheter employing a different technique to monitor compartmental pressure has been developed. The accuracy of the catheter was compared to a wick catheter and to the needle manometer technique for monitoring compartmental pressure. The slit catheter is the most accurate of the three techniques for continuous pressure monitoring for periods of up to 24 hours in the experimental canine model. The slit catheter is as accurate as the wick catheter for pressure measurements from 0 through 10 mm Hg. The needle technique has proven to be the least accurate of the three.