Accuracy of history, physical examination, cardiac biomarkers, and biochemical variables in identifying dogs with stage B2 degenerative mitral valve disease.

BACKGROUND: Treatment is indicated in dogs with preclinical degenerative mitral valve disease (DMVD) and cardiomegaly (stage B2). This is best diagnosed using echocardiography; however, relying upon this limits access to accurate diagnosis. OBJECTIVES: To evaluate whether cardiac biomarker concentrations can be used alongside other clinical data to identify stage B2 dogs. ANIMALS: Client-owned dogs (n = 1887) with preclinical DMVD prospectively sampled in Germany, the United Kingdom, and the United States. METHODS: Dogs that met inclusion criteria and were not receiving pimobendan (n = 1245) were used for model development. Explanatory (multivariable logistic regression) and predictive models were developed using clinical observations, biochemistry, and cardiac biomarker concentrations, with echocardiographically confirmed stage B2 disease as the outcome. Receiver operating characteristic curves assessed the ability to identify stage B2 dogs. RESULTS: Age, appetite, serum alanine aminotransferase activity, body condition, serum creatinine concentration, murmur intensity, and plasma N-terminal propeptide of B-type natriuretic peptide (NT-proBNP) concentration were independently associated with the likelihood of being stage B2. The discriminatory ability of this explanatory model (area under curve [AUC], 0.84; 95% confidence interval [CI], 0.82-0.87) was superior to NT-proBNP (AUC, 0.77; 95% CI, 0.74-0.80) or the vertebral heart score alone (AUC, 0.76; 95% CI, 0.69-0.83). A predictive logistic regression model could identify the probability of being stage B2 (AUC test set, 0.86; 95% CI, 0.81-0.91). CONCLUSION AND CLINICAL IMPORTANCE: Our findings indicate accessible measurements could be used to screen dogs with preclinical DMVD. Encouraging at-risk dogs to seek further evaluation could result in a greater proportion of cases being appropriately managed.

Gait analysis alters decision-making in cerebral palsy.

This study was designed to assess the impact of gait analysis on the treatment of patients with cerebral palsy. One hundred two ambulant patients with cerebral palsy were assessed clinically and with gait analysis. Separate treatment proposals for each patient were recorded after clinical examination and after gait analysis. The results of the two methods of assessment were compared. After clinical assessment, 71 of the 102 patients evaluated were recommended for a surgical procedure and 31 for nonoperative treatment. After gait analysis, the indications for treatment were confirmed in 91 cases (89%). Clinical assessment by the same orthopedic surgeon was in close agreement with gait analysis in identifying an indication for surgery. There was less agreement in the type or level of operation recommended. Gait analysis altered the decision in 106 of 267 operations (40%). There was good agreement for bone surgery, suggesting that clinical evaluation of torsional problems was fairly reliable. The poorer agreement seen for soft tissue operations probably reflects the difficulties in assessing tone-related problems in these patients clinically. This study confirms the value of gait analysis for decision-making in cerebral palsy.

Percutaneous angiography of Patent Ductus Arteriosus in dogs: techniques, results and implications for intravascular occlusion.

OBJECTIVES: To evaluate the percutaneous angiography and the morphology of patent ductus arteriosus (PDA) in dogs. BACKGROUND: In contrast to surgical ligation the knowledge of angiographic morphology is necessary for intravascular PDA occlusion. METHODS: Forty-nine dogs with a left to right shunting PDA were included in a three-year, prospective study. In 43 dogs with a body weight >/= 3.0 kg a percutaneous approach to brachial artery was tested. In six miniature dogs (< 3.0 kg) placement of angiographic catheter from femoral vein antegrade through the PDA was studied. Angiographic morphology and dimensions of PDA were analyzed. RESULTS: Percutaneous approach to brachial artery was performed successfully in 41/43 (95%) dogs, in the remaining 2 dogs this approach was not possible and the femoral artery had to be used. Two dogs did not survive the procedure. Arterial bleeding was not a problem in any of the 39 cases in which percutaneous brachial artery catheterization was performed. Two dogs developed transient radial nerve paralysis that resolved 4 to 6 days later. The transvenous technique was successful in all 6 small dogs. In 39 dogs there was an elongated conical duct (type E). A conical duct (type A) was found in nine dogs and one dog had a PDA with two constrictions (type D). The mean PDA minimal diameter was 3.78 +/- 1.55 mm (range 1.5 to 6.9), in 20/49 dogs (41%) the minimal PDA diameter measured more than 4.0 mm. CONCLUSIONS: Percutaneous catheterization of the brachial artery using a vascular introducer is feasible and entails minimal risk of hemorrhage. Angiographic evaluation of the ductus arteriosus is easily performed with this technique, but coilimplantation is not possible by this approach. The frequency of PDA-types is different in dogs and humans and the PDA minimal diameter is larger in dogs.

Análise comparativa da ressonância nuclear magnética com a artroscopia no diagnóstico das lesöes intra-articulares do joelho / Comparative study between MRI findings and arthroscooy in the diagnosis of knee intra-araticular lesions

Os autores analisaram os prontuários de 37 pacientes submetidos a artroscopia do joelho e que haviam realizado ressonância nuclear magnética prévia ao ato cirúrgico, com o objetivo de avaliar a eficácia deste método no diagnóstico das lesoes do joelho. A sensibilidade, especificidade e acurácia do método foram, respectivamente, de 94 por cento, 72 por cento e 83 por cento para menisco medial; de 81 por cento, 80 por cento e 83 por cento para menisco lateral; de 53 por cento, 95 por cento e 78 por cento para ligamento cruzado anterior; idefinida, 100 por cento e 100 por cento para ligamento cruzado posterior; e de 60 por cento, 86 por cento e 75 por cento para condromalácia. Os exames foram realizados por apenas um radiologista e a artroscopia, por um único cirurgiao, eliminado a variaçao interpessoal. Concluíram que a ressonância nuclear magnética é excelente exame para diagnosticar patologias meniscais, porém sua capacidade em verificar as lesoes do ligamento cruzado anterior e condromalácia nao corresponderam à expectativa.

Torcicolo muscular congênito: resultado do tratamento cirúrgico / Congenital torticollis: results of surgical management

Sao apresentados três casos de uma mesma família. portadores de osteólise idiopática com padrao de herança do tipo dominante autossômico e expressividade variável. Fazem-se comentários sobre os vários tipos de osteólises conhecidos e de outras afecçoes do esqueleto que devem entrar no diganóstico diferencial. Um dos pacientes. devido à gravidade do acomentimento nos quadris, necessitou de ressecçao das cabeças femorais. É descrito o resultado anatomopatológico das peças removidas.