The effect of mental fatigue on the performance of Australian football specific skills amongst amateur athletes

OBJECTIVES

This study investigated the effects of induced mental fatigue on the performance of Australian football (AF) specific skills amongst amateur AF players.

DESIGN

Randomised cross over trial.

METHODS

Twenty-five amateur AF players performed a series of standardised tests from the Australian Football League (AFL) Draft Combine after completing a 30-min Stroop test (mental fatigue condition) or 30-min control condition. The AFL Draft Combine tests included the standing vertical jump test, running vertical jump test, agility test, 20m sprint, Matthew Lloyd clean hands test, Brad Johnson goal kicking test and a Yo-Yo Intermittent Recovery Level 1 (Yo-Yo IR1) test.

RESULTS

The Stroop test score decreased during the Stroop test (first five trials: mean=84.7, SD=3.5; last five trials: mean=82.2, SD=5.0, p=0.03). The Yo-Yo IR1 test (mental fatigue: median=920m, IQR=400; control: median=1040m, IQR=760; p=0.03) and Brad Johnson goalkicking test (mental fatigue: median=19.0, IQR=5.0; control: median=25.0, IQR=10.0, p=0.048) were negatively affected by mental fatigue. No other Draft Combine tests demonstrated a negative affect from mental fatigue.

CONCLUSIONS

Mental fatigue had a detrimental influence on the performance of AF specific skills. The findings may have implications for AF players who are required to sustain attention and concentration for prolonged periods before and during matches.

Impact of postoperative complications on disease recurrence and long-term survival following oesophagogastric cancer resection

Background

Postoperative complications after resection of oesophagogastric carcinoma can result in considerable early morbidity and mortality. However, the long-term effects on survival are less clear.

Methods

All patients undergoing intentionally curative resection for oesophageal or gastric cancer between 2006 and 2016 were selected from an institutional database. Patients were categorized by complication severity according to the Clavien–Dindo classification (grades 0–V). Complications were defined according to an international consensus statement. The effect of leak and severe non-leak-related complications on overall survival, recurrence and disease-free survival was assessed using Kaplan–Meier analyses to evaluate differences between groups. All factors significantly associated with survival in univariable analysis were entered into a Cox multivariable regression model with stepwise elimination.

Results

Some 1100 patients were included, with a median age of 69 (range 28–92) years; 48·1 per cent had stage III disease and cancer recurred in 428 patients (38·9 per cent). Complications of grade III or higher occurred in 244 patients (22·2 per cent). The most common complications were pulmonary (29·9 per cent), with a 13·0 per cent incidence of pneumonia. Rates of atrial dysrhythmia and anastomotic leak were 10·0 and 9·6 per cent respectively. Patients with a grade III–IV leak did not have significantly reduced overall survival compared with those who had grade 0–I complications. However, patients with grade III–IV non-leak-related complications had reduced median overall survival (19·7 versus 42·7 months; P < 0·001) and disease-free survival (18·4 versus 36·4 months; P < 0·001). Cox regression analysis identified age, tumour stage, resection margin and grade III–IV non-leak-related complications as independent predictors of poor overall and disease-free survival.

Conclusion

Beyond the acute postoperative period, anastomotic leak does not adversely affect survival, however, other severe postoperative complications do reduce long-term overall and disease-free survival.

Contrast-enhanced computed tomography features of oblique and straight distal sesamoidean ligament injury in thirty-one horses

Distal sesamoidean ligament (DSL) injury is a recognized cause of lameness in horses. The purpose of this study was to describe the contrast-enhanced computer tomography (CE-CT) findings in horses with injury to the DSL compared to a control group without injury to the DSL. Medical records of horses referred for CE-CT between 2008 and 2015 were reviewed. Cases were selected retrospectively based on a CE-CT imaging finding of injury to the DSL. Three horses had DSL injury as the only finding, while the remaining horses had one or more concomitant injuries. DSL injury and fetlock trauma and/or suspensory branch desmitis were the most frequent injury combinations. CE-CT can be of value in diagnosing DSL injury. The high number of concurrent DSL and fetlock and/or suspensory lesions suggests that further investigation should be considered when evaluating horses with injuries related to either of these structures.

Multifocal osteomyelitis and abdominal abscessation in a warmblood foal

To the authors’ knowledge, this is the first report, in which a simultaneous occurrence of Salmonella-associated multifocal osteomyelitis and intra-abdominal abscessation in a foal presenting with weight loss, diarrhea and fever is described. No evidence of failure of passive immune transfer had been present at birth. Radiographic examination revealed multifocal type P osteomyelitis. Bacterial culture of synovial fluid revealed a Salmonella spp. Antibiotic treatment was adjusted based on the sensitivity results; however without clinical improvement. The foal developed abscess formations within the left femoral region, and finally a Salter Harris type I fracture of the left femur. Euthanasia was elected based on this finding. Post-mortem computed tomography revealed a large mass within the caudal abdomen that extended into the left pelvic and hind limb region, as well as multifocal osteomyelitis. Pathological examination identified the mass as a large abscess with multiple fistula tracts. Salmonella spp. was additionally cultured post mortem.

Changes in canine cerebral perfusion after accelerated high frequency repetitive transcranial magnetic stimulation (HF-rTMS): A proof of concept study

Repetitive transcranial magnetic stimulation (rTMS) has been proposed as a treatment for several neuropsychiatric disorders in human beings, but the neurobiological effects of rTMS in dogs have not been investigated to date. A proof of concept study was designed to evaluate the effect of rTMS on cerebral perfusion, measured with single photon emission computed tomography (SPECT), in dogs. An accelerated high frequency (aHF)-rTMS (20Hz) protocol was applied to the canine left frontal cortex. To accurately target this area, eight dogs underwent a 3 Tesla magnetic resonance imaging (MRI) scan before stimulation. The left frontal cortex was subjected to five consecutive aHF-rTMS sessions with a figure-of-eight coil designed for human beings at an intensity of 110% of the motor threshold. The dogs underwent ^99mTc-d,1 hexamethylpropylene amine oxime (HMPAO) SPECT scans 1 week prior to and 1day after the stimulations. Perfusion indices (PIs) were determined semi-quantitatively; aHF-rTMS resulted in significantly increased PIs in the left frontal cortex and the subcortical region, whereas no significant differences were noted for the other regions. Behaviour was not influenced by the stimulation sessions. As has been observed in human beings, aHF-rTMS applied to the left frontal cortex alters regional cerebral perfusion in dogs.

Contrast-Enhanced Ultrasound Examination for the Assessment of Renal Perfusion in Cats with Chronic Kidney Disease

Background

Contrast‐enhanced ultrasound examination (CEUS) is a functional imaging technique allowing noninvasive assessment of tissue perfusion. Studies in humans show that the technique holds great potential to be used in the diagnosis of chronic kidney disease (CKD). However, data in veterinary medicine are currently lacking.

Objectives

To evaluate renal perfusion using CEUS in cats with CKD.

Animals

Fourteen client‐owned cats with CKD and 43 healthy control cats.

Methods

Prospective case‐controlled clinical trial using CEUS to evaluate renal perfusion in cats with CKD compared to healthy control cats. Time‐intensity curves were created, and perfusion parameters were calculated using off‐line software. A linear mixed model was used to examine differences between perfusion parameters of cats with CKD and healthy cats.

Results

In cats with CKD, longer time to peak and shorter mean transit times were observed for the renal cortex. In contrast, a shorter time to peak and rise time were seen for the renal medulla. The findings for the renal cortex indicate decreased blood velocity and shorter total duration of enhancement, likely caused by increased vascular resistance in CKD. Increased blood velocity in the renal medulla has not been described before and may be because of a different response to regulatory factors in cortex and medulla.

Conclusions and Clinical Importance

Contrast‐enhanced ultrasound examination was capable of detecting perfusion changes in cats with CKD. Further research is warranted to assess the diagnostic capabilities of CEUS in early stage of the disease process.

Evaluation of Renal Perfusion in Hyperthyroid Cats before and after Radioiodine Treatment

Background

Hyperthyroidism and chronic kidney disease (CKD) are common in elderly cats. Consequently, both diseases often occur concurrently. Furthermore, renal function is affected by thyroid status. Because changes in renal perfusion play an important role in functional renal changes in hyperthyroid cats, investigation of renal perfusion may provide novel insights.

Objectives

To evaluate renal perfusion in hyperthyroid cats with contrast‐enhanced ultrasound (CEUS).

Animals

A total of 42 hyperthyroid cats was included and evaluated before and 1 month after radioiodine treatment.

Methods

Prospective intrasubject clinical trial of contrast‐enhanced ultrasound using a commercial contrast agent (SonoVue) to evaluate renal perfusion. Time‐intensity curves were created, and perfusion parameters were calculated by off‐line software. A linear mixed model was used to examine differences between pre‐ and post‐treatment perfusion parameters.

Results

An increase in several time‐related perfusion parameters was observed after radioiodine treatment, indicating a decreased blood velocity upon resolution of the hyperthyroid state. Furthermore, a small post‐treatment decrease in peak enhancement was present in the renal medulla, suggesting a lower medullary blood volume.

Conclusions and Clinical Importance

Contrast‐enhanced ultrasound indicated a higher cortical and medullary blood velocity and higher medullary blood volume in hyperthyroid cats before radioactive treatment in comparison with 1‐month post‐treatment control.

Pyothorax in cats and dogs

Pyothorax, or thoracic empyema, is an infection of the pleural space, characterized by the accumulation of purulent exudate. It is a life-threatening emergency in dogs as well as in cats, with a guarded prognosis. Dyspnea and/or tachypnea, anorexia and lethargy are the most typical clinical signs. Diagnosis is usually straightforward, based on the clinical symptoms combined with pleural fluid analysis, including cytology and bacterial culture. Most commonly, oropharyngeal flora is isolated in the pleural fluid. Treatment can be medical or surgical, but needs to be immediate and aggressive. In this article, an overview of the various causes of both feline and canine pyothorax with its similarities and differences is provided. Epidemiology, symptoms, diagnosis, treatment and prognosis are discussed.

Postoperative survival following perioperative MAGIC versus neoadjuvant OE02-type chemotherapy in oesophageal adenocarcinoma

The optimal management of resectable oesophageal adenocarcinoma is controversial, with many centres using neoadjuvant chemotherapy following the Medical Research Council (MRC) oesophageal working group (OE02) trial and the MRC Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial. The more intensive MAGIC regimen is used primarily in gastric cancer but some also use it for oesophageal cancer. A database of cancer resections (2001-2013) provided information on survival of patients following either OE02 or MAGIC-type treatment. The data were compared using Kaplan-Meier analysis. Straight-to-surgery patients were also reviewed and divided into an 'early' cohort (2001-2006, OE02 era) and a 'late' cohort (2006-2013, MAGIC era) to estimate changes in survival over time. Subgroup analysis was performed for responders (tumour regression grade [TRG] 1-3) versus non-responders (TRG 4 and 5) and for anatomical site (gastro-oesophageal junction [GOJ] vs oesophagus). An OE02 regimen was used for 97 patients and 275 received a MAGIC regimen. Those in the MAGIC group were of a similar age to those undergoing OE02 chemotherapy but the proportion of oesophageal cancers was higher among MAGIC patients than among those receiving OE02 treatment. MAGIC patients had a significantly lower stage following chemotherapy than OE02 patients and a higher median overall survival although TRG was similar. On subgroup analysis, this survival benefit was maintained for GOJ and oesophageal cancer patients as well as non-responders. Analysis of responders showed no difference between regimens. 'Late' group straight-to-surgery patients were significantly older than those in the 'early' group. Survival, however, was not significantly different for these two cohorts. Although the original MAGIC trial comprised few oesophageal cancer cases, our patients had better survival with MAGIC than with OE02 chemotherapy in all anatomical subgroups, even though there was no significant change in operative survival over the time period in which these patients were treated. The use of the MAGIC regimen should therefore be encouraged in cases of operable oesophagogastric adenocarcinoma.

Congenital anomalies of the vertebrae in dogs

In this review article, a overview is given of the congenital pathologies of vertebrae in the dog. These pathologies are common in dogs and can be divided in two major groups: neural tube defects or spinal dysraphism, such as spina bifida with or without meningocoele and dermal sinus tract, and congenital anomalies of the vertebral column. The latter group can be subdivided in malformations originating in the embryonic period of development, such as butterfly vertebra, mediolateral wedged vertebra and transitional vertebra, or in the foetal period, such as block vertebra and dorsoventral wedged vertebra. Congenital vertebral anomalies can be incidental findings on radiographs or CT, but sometimes they can be the underlying cause of a clinical, mostly neurological problem. Due to pressure on the spinal cord, symptoms, such as pelvic limb ataxia, paresis, loss of spinal reflexes, incontinence and atrophy of the pelvic limbs may occur.

Hyperthyroidism in cats

In the first part of this review article, thyroid anatomy, physiology and pathophysiology are reviewed to continue more specifically on hyperthyroidism, the most common thyroid disorder in cats. The diagnostic work-up of this disorder is discussed with emphasis on thyroid gland imaging. Scintigraphy is most commonly used and best suited to assess thyroid function, which will be discussed extensively in the second part of this review article. All other available imaging modalities do not offer a functional assessment and are therefore of limited use in the diagnosis and evaluation of hyperthyroidism.

Traumatische hernia diafragmatica gecompliceerd met tensiegastrothorax bij een hond

Een tien maanden oude, mannelijke cavalierkingcharles-spaniël werd twee maanden na een abdominaal bijttrauma aangeboden met inspiratoire dyspnee en positionele pijnklachten. Afwezige long- en hartgeluiden bij auscultatie van de linkerhemithorax deden traumatische hernia diafragmatica vermoeden. Radiografische opnamen bevestigden dit maar bijkomend werd tympanie van de gehernieerde maag vastgesteld. Dit wordt tensiegastrothorax genoemd en is steeds een acute levensbedreigende complicatie van de hernia. Omwille van de progressief verergerende cardiorespiratoire toestand en het onvermogen om de maag te sonderen werd overgegaan tot een spoedoperatie. Via standaard chirurgische benadering werd de maag geherpositioneerd en de traumatische hernia diafragmatica hersteld. Het postoperatief herstel verliep ongecompliceerd en één jaar na de operatie stelde de hond het nog steeds goed.

Hyperthyroidism in cats

In the second part of this review article , the diagnostic aspects of thyroid scintigraphy are discussed, with major emphasis on hyperthyroidism, followed by an overview of radioiodine treatment.

Diagnostic imaging and endoscopic finding in dogs and cats with gastric tumors: a review

Medical imaging is an essential part of the diagnostic workup of many gastrointestinal disorders. This paper reviews imaging and endoscopy of gastric tumors in dogs and cats and the techniques used. The appearance of the normal as well as the various aspects of gastric tumors are described for these different modalities. Plain radiography is widely available but has limited diagnostic value. Contrast radiography has higher sensitivity but is laborious and time-consuming. Ultrasonography (if an adequate acoustic window is available), endosonography and endoscopy are the most appropriate modalities for diagnosing gastric tumors. They are especially useful when obtaining samples for cytologic or histopathologic examination, because the imaging modalities do not always differentiate between inflammatory or infectious conditions and neoplastic disorders. Hydro-helical CT was found helpful for evaluating the location and local invasiveness of the lesion. Ultrasonography and endoscopy are useful modalities for taking adequate biopsies.

Description of the use of contrast-enhanced ultrasonography in four dogs with pancreatic tumours

Canine pancreatic tumours are rare compared to human medicine and the detection and differentiation of pancreatic neoplasia is challenging with B-mode ultrasonography, which often leads to late clinical diagnosis and poor prognosis. This case report describes the findings of contrast-enhanced ultrasonography in four dogs with pancreatic adenocarcinoma or insulinoma. B-mode ultrasonography of the pancreas revealed a hypoechoic nodule in three dogs and heterogenous tissue in one dog. Contrast-enhanced ultrasonography was able to differentiate between two tumour types: adenocarcinomas showed hypoechoic and hypovascular lesions, whereas insulinomas showed uniformly hypervascular lesions. Contrast-enhanced ultrasonography findings were confirmed by cytology and/or histopathology. The results demonstrated that contrast-enhanced ultrasonography was able to establish different enhancement patterns between exocrine (adenocarcinoma) and endocrine (insulinoma) tumours in dogs.

Effect of propofol anesthesia on ultrasonographic measurements of the adrenal glands of healthy cats

Although real-time ultrasonography is feasible in awake cats, cats are frequently anesthetized with propofol, if they are uncooperative or during perioperative ultrasonographic examinations. Propofol induces hypotension in cats and may cause venous vasodilation that redistributes blood volume in abdominal organs and organomegaly. In this paper, ultrasonographic adrenal measurements are compared before and during intravenous propofol anesthesia in healthy cats. No significant effect of propofol anesthesia on adrenal size was found, and the observed differences were small and clinically irrelevant. Therefore, it can be concluded that propofol anesthesia does not prevent ultrasonographic diagnosis of adrenomegaly.

Clinical, radiographic, ultrasonographic and computed tomographic features of nonseptic osteitis of the axial border of the proximal sesamoid bones

REASONS FOR PERFORMING STUDY

Lysis of the axial aspect of equine proximal sesamoid bones (PSBs) is a rare condition reported to have septic or traumatic origins. Limited information exists regarding imaging of nonseptic axial osteitis of a PSB.

OBJECTIVES

To report the clinical, radiographic, ultrasonographic, computed tomographic and intra-arterial contrast-enhanced computed tomographic abnormalities in horses with axial nonseptic osteitis of a PSB.

STUDY DESIGN

Retrospective clinical study.

METHODS

Eighteen horses diagnosed with nonseptic osteitis of the axial border of a PSB between 2007 and 2012 were reviewed retrospectively. Case details, clinical examination, radiographic, ultrasonographic, computed tomographic and intra-arterial/intra-articular contrast-enhanced computed tomographic features were recorded, when available. Radiographic, ultrasonographic and computed tomographic evaluations of the fetlock region had been performed on 18, 15 and 9 horses, respectively. The effect of the degree of lysis on the grade and duration of lameness was determined.

RESULTS

All horses had chronic unilateral lameness, 4 with forelimb and 14 with hindlimb signs. On radiographs, lysis was identified in both PSBs in 14 horses, one PSB in 3 horses and in one horse no lysis was identified. The degree of osteolysis was variable. Ultrasonography identified variably sized irregularities of the bone surface and alteration in echogenicity of the palmar/plantar ligament (PL). All horses undergoing computed tomographic examination (n = 9) had biaxial lysis. The lesions were significantly longer and deeper on computed tomographic images compared with radiographic images. Intra-arterial contrast-enhanced computed tomography may reveal moderate to marked contrast enhancement of the PL. There was no significant effect of the degree of lysis on the grade and duration of lameness.

CONCLUSIONS

Lesions of nonseptic axial osteitis of a PSB can be identified using a combination of radiography and ultrasonography. Computed tomography provides additional information regarding the extent of the pathology.

Colorectal cancer is reliably excluded in the frail and elderly population by minimal preparation CT

BACKGROUND

This study aimed to retrospectively assess the accuracy of minimal preparation computed tomography (MPCT) in the detection of colorectal cancer (CRC) within the frail and elderly population and to evaluate the relevance of extra-colonic findings (ECF).

METHODS

Radiology reports, clinical notes and follow-up reports from 207 patients who underwent MPCT to investigate for CRC between 2005 and 2009 were analysed. Patients were scanned following the administration of oral contrast for 48 h, without bowel preparation or colonic insufflation. MPCT results were measured against patient outcomes, with a minimum of 2 years of follow-up.

RESULTS

Twelve cases of clinically relevant CRC were confirmed (5.8 %). MPCT correctly identified 11 of these lesions (sensitivity 91.6 %). Thirty-one patients had a possible CRC identified by MPCT, which was not confirmed by further examination (specificity 84.1 %). This results in a positive predictive value of 26.2 % and a negative predictive value of 99.4 %. Five of the patients with colon cancer underwent curative surgery. Sixty-eight clinically relevant ECF were confirmed, including 14 previously undiagnosed extra-colonic malignancies. ECF were considered to account for the presenting complaint in 15.0 % (31/207) of all patients.

CONCLUSIONS

Minimal preparation computed tomography is an effective and reliable investigation for the exclusion of clinically relevant CRC in this population. It provides clinicians with a valuable and pragmatic alternative to colonoscopy and CT colonography when invasive examination or cathartic bowel preparation will be poorly tolerated and small polyps are of limited significance. MPCT has an advantage over purely luminal imaging in the detection of extra-colonic pathology and appears to have an equally important role in the detection of CRC.

Ureterobstructie bij een ragdoll ten gevolge van calciumoxalaat-urolithiasis

In deze casuïstiek wordt een vrouwelijke, gesteriliseerde ragdoll beschreven met een ureterobstructie door calciumoxalaat-urolieten. De patiënt werd aangeboden omwille van polyurie/polydipsie. Bij abdominale palpatie werd unilaterale renomegalie vastgesteld. Met behulp van radiografi sch en echografi sch onderzoek kon de diagnose van multipele nefro- en ureterolieten gesteld worden waarbij één uroliet een obstructie van de linkerureter veroorzaakte. De kat werd gehospitaliseerd om met infuustherapie de azotemie te bestrijden, de diurese te verbeteren en zo de passage van de ureterale calculi doorheen de ureter te stimuleren. De therapie bleek echter niet succesvol te zijn en daarom werd de obstruerende ureteroliet chirurgisch via een cystotomie verwijderd. Na kwantitatieve steenanalyse bleek het om calciumoxalaat-urolithiasis te gaan en een dieet aangepast aan urolithiasis werd opgestart. In de daaropvolgende periode van ongeveer één jaar bleef de patiënt klinisch stabiel. De kat vertoonde persisterende polyurie/polydipsie zonder azotemie. Nieuwe, nietobstruerende ureterolieten in de linkerureter werden aangetoond via echografi e. Aangezien de kat geen klinische symptomen vertoonde behalve de persisterende PU/PD liet de eigenares geen verdere echografi sche/radiografi sche controle van het abdomen meer uitvoeren.

Catheter-directed thrombolysis for iliofemoral deep vein thrombosis

BACKGROUND

Recent international guidance recommends the use of catheter-directed thrombolysis (CDT) in selected patients with symptomatic iliofemoral deep vein thrombosis (DVT). The aim of this study was to estimate the potential increase in workload as a result of this recommendation.

METHODS

Using the radiology database, a review was performed of all DVTs diagnosed between August 2010 and February 2012 at a large tertiary referral hospital. The National Institute for Health and Clinical Excellence and American College of Chest Physicians guidance was applied retrospectively to this cohort, using case-note review by two independent clinicians to determine which patients would have been suitable for CDT.

RESULTS

Some 563 patients had DVT confirmed radiologically over the 18-month interval. Fifty-three of the 128 patients with iliofemoral DVT would have been eligible for intervention with CDT, equivalent to 4·4 patients per 100 000 per year. Only eight (15 per cent) of the 53 were actually referred to vascular services for treatment. All eight patients had successful CDT, which involved a stay in critical care for monitoring (median 2 (range 1-3) sessions).

CONCLUSION

Vascular units should be prepared for a major increase in the requirement for CDT for iliofemoral DVT. This increase will affect inpatient beds, the interventional radiology suite, critical care and interhospital referrals.

Computed tomographic features of lesions detected in horses with tarsal lameness

REASONS FOR PERFORMING STUDY

Tarsal pain is a common cause of hindlimb lameness in horses. Diagnosis can usually be made with radiography and ultrasonography; however, in some cases, these techniques are inconclusive and additional imaging is necessary. No studies describing computed tomography (CT) features of different tarsal lesions in horses with tarsal lameness are reported.

OBJECTIVES

Our aims were as follows: 1) to characterise CT abnormalities in horses with tarsal lameness; 2) to compare CT findings with those from other imaging techniques; and 3) to assess whether CT can help to diagnose tarsal pathology.

STUDY DESIGN

Retrospective case series.

METHODS

Computed tomography of the tarsus was performed on 15 horses (n = 17 joints) with tarsal lameness. The horses were divided into 3 groups depending on the reason for CT examination, as follows: 1) other imaging techniques were inconclusive; 2) evaluation of a fracture; or 3) other imaging techniques showed tarsal lesions, and CT was performed to assess whether additional lesions were present.

RESULTS

Group 1 included 7 horses. Lesions detected with CT included subchondral cyst-like lesions (2 horses); an osteolytic lesion in the cochlea tibiae (one horse); degenerative changes of the distal tarsal joints (2 horses); osteolytic lesions tarsometatarsal joint (one horse); and sclerosis of the third tarsal bone with a lesion of the tarsometatarsal interosseous ligament (one horse). In this group, CT provided information on the character and extent of the lesion that was not available with other imaging techniques. Computed tomography revealed more information about the extent and complexity of the fracture than radiography in Group 2, whereas CT did not provide extra information in Group 3.

CONCLUSIONS

Focal lesions located between the tarsal bone surfaces are difficult or even impossible to detect with radiography and ultrasonography, but they can be detected and characterised with CT.

POTENTIAL RELEVANCE

Computed tomography of the tarsus should be considered when radiography and ultrasonography are inconclusive, or for further evaluation of tarsal fractures.

Evaluation of semi-quantitative bone scintigraphy in canine elbows

Scintigraphy is an extremely sensitive tool for the detection of early changes in bone metabolism. Sixty-eight lame dogs underwent a scintigraphic examination. For each elbow lateromedial (LM), caudomedial (CdM) flexed and caudomedial (CdM) extended scintigraphic views were obtained. Semi-quantitative analysis was performed to determine radiopharmaceutical uptake at the medial coronoid process (MCP) and at the attachment of the flexor muscles at the medial humeral epicondyle, normalised to activity registered in either the total elbow joint or the radius/ulna. MCP pathology/flexor enthesopathies were divided into simple (containing one abnormality) or complex (containing more than one abnormality) lesions. The influence of different views or normalisation procedures on sensitivity and specificity was evaluated. MCP lesions were detected on radiography, ultrasound, computed tomography, magnetic resonance imaging and/or arthroscopy in 49 elbows, with 13 simple and 36 complex lesions. Flexor enthesopathy was diagnosed in 54 elbows, with 14 simple and 40 complex lesions. In seven elbows only degenerative changes were present, whereas in 50 elbows no abnormalities could be detected. MCP lesions were best detected with the CdM extended view, whereas for flexor enthesopathy the CdM flexed view offered the best result. To detect simple lesions, the normalisation procedure to the elbow gave the best result, whereas normalisation to the radius/ulna was the best choice for complex lesions. This study suggests that semi-quantification is a valuable method in case of simple pathology, especially when MCP lesions are considered. For elbows with complex lesions, the quantification procedure is less reliable.

The histological appearance of the proximal aspect of the dorsal condylar sagittal ridge of the third metacarpal and metatarsal bone in young warmblood horses: normal appearance and correlation with detected radiographic variations

The objective of this study is to describe the normal histological appearance of the dorsoproximal aspect of the sagittal ridge of the third metacarpal/metatarsal bone in young Warmblood horses, and to compare it to the different radiographic variations (irregular, indentation, lucency, notch) described at this level. A total of 25 metacarpo/metatarsophalangeal joints of 12 Warmblood horses were used. Five samples of each radiographically described group were selected for histological processing. Each category was compared with the normal control group. Each group showed a bone cortex, covered by hyaline cartilage and longitudinally aligned collagen fibres covered by loosely organized connective tissue proximally. The normal and irregular group showed a smooth bone cortex. In the indentation and lucency group, a depression in the cortex was detected. The notch group presented an expansion of the cortex. The collagen fibres and connective tissue were located in the depression in the indentation group whereas the location varied in the lucency and notch group. The radiologic detected differences are translated into detectable histological differences. Further research is warranted to determine whether these variations are developmental or congenital and to evaluate their potential influence on the joint function during hyperextension.

Cross-sectional anatomy and comparative ultrasonography of the equine medial femorotibial joint and its related structures

REASONS FOR PERFORMING STUDY

Injuries of the equine stifle are frequent causes of hindlimb lameness. Ultrasonography is useful for the diagnosis of many soft tissue lesions but, until recently, its application to the equine stifle has been limited to a description of normal and abnormal structures. A comparative study using gross anatomical sections to identify all structures visible on ultrasonographic images of the equine stifle has not previously been reported.

OBJECTIVES

To provide a comprehensive comparative cross-sectional atlas of the normal equine medial femorotibial (MFT) joint and its related structures using ultrasonography.

METHODS

The stifle joints of 15 cadaver limbs were examined ultrasonographically using a systematic approach. Ten different scanning planes were defined. The lateral and medial femorotibial and the femoropatellar joints were injected with pigments of different colours. Each leg was frozen (10 in extension and 5 in flexion) and cut into slices corresponding to the different scanning planes. According to the different ultrasonographic reference images, 10 representative anatomical images were selected and digitised.

RESULTS

All bony and soft tissue structures were identified on the anatomical sections and subsequently located on the corresponding ultrasonographic images, except the caudal meniscotibial ligaments. Visualisation of the cruciate ligaments was a challenge due to their position and oblique orientation.

CONCLUSIONS

Ultrasonography is a very useful technique for imaging both soft tissue and bony structures of the MFT joint and its related structures, although a protocol is required to perform a systematic and standardised ultrasonographic examination. Good anatomical knowledge is mandatory for identification of the different structures.

POTENTIAL RELEVANCE

This study should contribute to 1) knowledge of the ultrasonographic anatomy of the equine MFT joint and its related structures, 2) use of a protocol for a standardised ultrasonographic examination and 3) the ability to recognise abnormal structures.

Short- and long-term follow-up of glomerular and tubular renal markers of kidney function in hyperthyroid cats after treatment with radioiodine

Hyperthyroidism can mask co-existing chronic kidney disease (CKD). Previous studies showed that post-treatment renal azotemia can be predicted by pre-treatment assessment of glomerular filtration rate (GFR). We hypothesized that treatment of hyperthyroidism may have different effects on glomerular and tubular function and these changes might be predicted by additional pre-treatment variables than GFR. Serum total T4 (TT4), creatinine and blood urea nitrogen (BUN), blood pressure (BP), body weight (BW), GFR, urine specific gravity (USG), urinary protein/creatinine ratio (UPC) and retinol binding protein/creatinine ratio (uRBP/c) were evaluated before and 1, 4, 12 and 24 weeks post-treatment with radioiodine ((131)I) in 21 non-azotemic hyperthyroid cats. Cats were divided 24 weeks post-treatment into group A (normal kidney function, n=16) and group B (impaired kidney function, n=5). Serum TT4, GFR, UPC and uRBP/c decreased significantly after treatment for the complete group and group A (P<0.05), although GFR and uRBP/c did not change in group B. Serum creatinine and BW increased significantly from 1 week after treatment (P<0.05). There was no change in BUN, USG or BP. Pre-treatment serum TT4, GFR and USG differed significantly between group A and B (P<0.05). GFR at 4 weeks after treatment and maximum decrease in GFR could be partially predicted by a formula using pre-treatment GFR, serum TT4, serum creatinine, BUN and/or USG. Significant changes in kidney function occur within 4 weeks post-treatment and none thereafter. Pre-treatment measurement of GFR, USG and serum TT4 can have possible predictive value regarding the development of post-treatment renal azotemia.

Thyroid imaging in the dog: current status and future directions

This review describes the advantages and disadvantages of radiography, ultrasonography, and nuclear medicine in the 2 most frequent thyroid pathologies of the dog: acquired primary hypothyroidism and thyroid neoplasia. Ultrasonography and scintigraphy remain the 2 most indicated imaging modalities for these thyroid abnormalities. However, as in human medicine, computed tomography and magnetic resonance imaging also have potential indications. This is especially the case in the evaluation of the extent, local invasiveness, and local or distant metastases of thyroid neoplasia. Based on experience with different imaging modalities in people, we suggest future directions in the imaging of the canine thyroid gland.

Ultrasonographic assessment of fracture healing after plate osteosynthesis

The goals of this study were to assess the ability of ultrasonography (US) to assess uncomplicated fracture healing and to establish normal images. Twenty-two dogs, ranging in age from 6 to 180 months were studied. Body weight ranged from 2.2 to 60 kg. All fractures were treated by plate osteosynthesis. US (B-mode and power Doppler) and radiography were performed until both were consistent with complete healing. B-mode US was performed in all dogs, and power Doppler US in 14. Fracture healing was judged to be complete based on US earlier than when based on radiography. The tissue immediately adjacent to the plate appeared vascularized on power Doppler images at a time when the tissue at the fracture site had a negative power Doppler exam. US appears useful for assessment of primary fracture healing and power Doppler was useful for detecting vascularization at the fracture site in nonhealed fractures. Power Doppler interrogation should be performed away from any metal implant, as a result from an interrogation adjacent to an implant will not reflect actual vascularization at the fracture site.

Interobserver agreement in the diagnosis of canine hip dysplasia using the standard ventrodorsal hip-extended radiographic method

OBJECTIVES

To determine the agreement between observers and to investigate the effect of observer experience in diagnosing canine hip dysplasia and providing final scoring of hips using the standard ventrodorsal hip-extended radiographic method. The agreement of the final scoring, with a presumed correct assessment based on the Norberg angle, is also investigated.

METHODS

Thirty observers were requested to read 50 ventrodorsal hip-extended radiographs of 25 dogs according to Federation Cynologique International criteria. Groups of experienced (nine members) and inexperienced (21 members) observers were used.

RESULTS

For providing the distinction between dysplastic versus non-dysplastic dogs, the average interobserver agreement was 72 per cent and was significantly higher (P<0.0001) than the score that could be expected by chance without any agreement between observers. For providing the final score (A, B, C, D or E), an average interobserver agreement of 43.6 per cent was found. In the experienced group, an agreement score of 76 per cent was found for the distinction between AB versus non-AB and an agreement score of 81 per cent was found for the distinction between C versus non-C. The agreement score was significantly higher (P<0.0001) for the experienced group than for the inexperienced group in all cases. Agreement between the presumed correct assessment based on the Norberg angle and the observer's evaluation was low (P=0.35), irrespective of whether the observers were experienced (71.8 per cent correct assessments) or inexperienced (69 per cent correct assessments).

CLINICAL SIGNIFICANCE

Although interobserver agreement is low, observer experience increases agreement.

Idiopathic megaoesophagus and intermittent gastro-oesophageal intussusception in a cat

An eight-month-old domestic shorthair cat was presented with chronic vomiting for three months, with an acute increase in frequency during the past two days. A diagnosis of megaoesophagus was made by chest radiography. Diagnostic work-up for megaoesophagus was performed. A gastro-oesophageal intussusception was identified during endoscopy. Medical and nutritional therapy was instituted with a good response to the treatment.