Epidemiologic trend of pediatric inflammatory bowel disease in Latin America: The Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) Working Group.

INTRODUCTION AND AIMS: The primary aim was to explore the epidemiologic trend of pediatric inflammatory bowel disease in Latin America, and the secondary aims were to obtain an overview of the diagnostic/therapeutic focus of the members of the LASPGHAN and examine the relation of case frequency to year, during the study period. MATERIALS AND METHODS: Latin American pediatric gastroenterologists participated in an online survey, conducted through the SurveyMonkey platform, that investigated the yearly frequency of new inflammatory bowel disease patients within the time frame of 2005-2016, their disease variety, the gastrointestinal segments affected, and the diagnostic and treatment methods utilized. The correlation of new case frequency with each study year was evaluated. RESULTS: A total of 607 patients were studied. The diagnoses were ulcerative colitis in 475 (78.3%) cases, Crohn's disease in 104 (17.1%), and inflammatory bowel disease D unclassified in 28 (4.6%). The trend in ulcerative colitis was a lineal increase in the frequency of new cases related to each study year, with a significant correlation coefficient. Pancolitis was found in 67.6% of the patients. The diagnostic methods included clinical data, endoscopy, and biopsies in more than 99% of the cases, and imaging studies were indicated selectively. Drug regimens were limited to 5-aminosalicylic acid derivatives, azathioprine, 6-mercaptopurine, infliximab, and adalimumab. CONCLUSIONS: Pediatric inflammatory bowel disease in Latin America appears to have increased during the years included in the study period, with a predominance of moderate or severe ulcerative colitis. That lineal trend suggests the predictive likelihood of a gradual increase in the coming years, with possible epidemiologic and clinical implications.

Epidemiologic trend of pediatric inflammatory bowel disease in Latin America: The Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) Working Group. / Tendencia epidemiológica de la enfermedad intestinal inflamatoria en pacientes pediátricos en América Latina: Grupo de Trabajo en Enfermedad Intestinal Inflamatoria, Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (SLAGHNP).

INTRODUCTION AND OBJECTIVES: The primary aim was to explore the epidemiologic trend of pediatric inflammatory bowel disease in Latin America, and the secondary aims were to obtain an overview of the diagnostic/therapeutic focus of the members of the LASPGHAN and examine the relation of case frequency to year, during the study period. MATERIALS AND METHODS: Latin American pediatric gastroenterologists participated in an online survey, conducted through the SurveyMonkey platform, that investigated the yearly frequency of new inflammatory bowel disease patients within the time frame of 2005 to 2016, their disease variety, the gastrointestinal segments affected, and the diagnostic and treatment methods utilized. The correlation of new case frequency with each study year was evaluated. RESULTS: A total of 607 patients were studied. The diagnoses were ulcerative colitis in 475 (78.3%) cases, Crohn's disease in 104 (17.1%), and inflammatory bowel disease D unclassified in 28 (4.6%). The trend in ulcerative colitis was a lineal increase in the frequency of new cases related to each study year, with a significant correlation coefficient. Pancolitis was found in 67.6% of the patients. The diagnostic methods included clinical data, endoscopy, and biopsies in more than 99% of the cases, and imaging studies were indicated selectively. Drug regimens were limited to 5-aminosalicylic acid derivatives, azathioprine, 6-mercaptopurine, infliximab, and adalimumab. CONCLUSIONS: Pediatric inflammatory bowel disease in Latin America appears to have increased during the years included in the study period, with a predominance of moderate or severe ulcerative colitis. That lineal trend suggests the predictive likelihood of a gradual increase in the coming years, with possible epidemiologic and clinical implications.

Radiography of the distal extremity of the manus in the donkey foal: Normal images and quantitative characterization from birth to 2 years of age: A pilot study.

This study describes a radiographic survey of the anatomical development of the distal extremity of the manus in the donkey from 0 to 2 years of age. The right distal limb of 10 donkey foals, born in the spring of 2012, underwent radiographs every month for the first 6 months of age and every 3 months during the following 18 months. Latero-medial radiographs with and without barium marker at the coronary band and dorso-palmar radiographs with both front feet in weight bearing were obtained. The distal physis of the third metacarpal bone and the proximal physis of the proximal phalanx (phalanx proximalis) were closed at the mean age of 18.6 months. The distal physis of the proximal phalanx appeared as a clear radiolucent line at 2 weeks of age and was still subtly visible in some donkeys at 24 months. The proximal physis of the middle phalanx (phalanx media) was closed at the mean age of 16.7 months. The distal physis of this phalanx was visible at birth, but closed at 4 days. The distal phalanx (phalanx distalis) was triangular at birth. At the age of 20-21 months, the palmar processes (processus palmares) were both developed. The navicular bone (os sesamoideum distalis) was developed at the mean age of 9 months. The proximal sesamoid bones (ossa sesamoidea proximalia) were seen in continuously development during the 24 months. It seems that the physes in the distal extremity of the manus in the donkey close at an older age than the physes in the horse.

Neonatal Serial Transverse Enteroplasty (STEP): Case Report.

CASE REPORT: Gastroschisis is the most frequent congenital abdominal wall defect. When associated with intestinal atresia (complex gastroschisis), short bowel syndrome may occur. Complicated gastroschisis is the most frequent cause of short bowel syndrome in our series. The serial transverse enteroplasty procedure has been used to lengthen the bowel and achieve intestinal rehabilitation in patients with dilated gut. The use of this technique in the newborn period, for tailoring the bowel while preserving absorptive mucosa, has been recently described. We present a video showing the surgical treatment of an intestinal obstruction produced by a complex intestinal atresia in a newborn baby in whom a primary closure of a gastroschisis had been done at birth. During laparotomy at the 21st day of life, a type IVa intestinal atresia was found, associated with a colonic stenosis. Proximal dilated jejunum was tailored with a serial transverse enteroplasty procedure, as shown in the video. End-to-end jejunal-ileal anastomosis was performed. Postoperative entero-cutaneous fistula occurred and was treated with vacuum-assisted therapy. Enteral feedings were initiated at 15 days after surgery. Parenteral nutrition was withdrawn at 30 days. After 16 months follow-up, actual weight was 8.7 kg (percentile 10% to 25%). The patient remained on full enteral feedings. CONCLUSIONS: In cases of intestinal atresia, short bowel syndrome, and proximal dilated bowel, we propose an aggressive surgical approach to preserve bowel mucosal surface while tailoring the jejunal loop to improve motility. The serial transverse enteroplasty procedure is an acceptable alternative to tailoring methods that resect a segment of the bowel wall.

Ultrasonographic percutaneous anatomy of the atlanto-occipital region and indirect ultrasound-guided cisternal puncture in the dog and the cat.

Cisternal puncture in dogs and cats is commonly carried out. This article describes the percutaneous ultrasound anatomy of the cisternal region in the dog and the cat and an indirect technique for ultrasound-guided cisternal puncture. Ultrasound images obtained ex vivo and in vivo were compared with anatomic sections and used to identify the landmarks for ultrasound-guided cisternal puncture. The ultrasound-guided procedure was established in cadavers and then applied in vivo in seven dogs and two cats. The anatomic landmarks for the ultrasound-guided puncture are the cisterna magna, the spinal cord, the two occipital condyles on transverse images, the external occipital crest and the dorsal arch of the first cervical vertebra on longitudinal images. Using these ultrasound anatomic landmarks, an indirect ultrasound-guided technique for cisternal puncture is applicable in the dog and the cat.

Morphometric analyses of the body and the branches of the normal third interosseous muscle (suspensory ligament) in Standardbreds.

The third interosseous muscle (suspensory ligament, TIOM) is composed of connective tissue (CT) with a variable proportion of muscle (MT) and adipose tissue (AT). The aim of our study is to quantify the CT, MT and AT within the body and the branches of right thoracic and pelvic limbs TIOM in sound horses to determine whether there are differences in CT, MT and AT between age, sex, limbs and levels. Right limbs from 11 sound horses were collected. Samples from 6 levels of the TIOM were embedded in paraffin or in Tissue-Tek(®) . Most of the paraffin sections were shredded. Using the cryosection, some artefacts appeared. Cryoprotection was carried out, which produced the best results. Hematoxylin-phloxine-saffron and Hematoxylin-eosin gave a good contrast of colours between the tissues observed allowing the use of an image analysis programme to calculate percentage of each tissue within the TIOM. The percentage of MT and AT decreased significantly (P < 0.0001), whereas the percentage of CT increased significantly (P < 0.0001) with age and when descending from the proximal to the distal level of the TIOM. The percentage of MT was significantly higher (P < 0.0001) in females than males, while the percentage of CT was significantly higher (P < 0.0001) in males than females. The percentage of AT was significantly higher (P = 0.0278) in pelvic limbs than in thoracic limbs. These results confirm the variation in tissue composition within the TIOM of sound horses.

Do developmental orthopaedic disorders influence future jumping performances in Warmblood stallions?

REASONS FOR PERFORMING THE STUDY: Few reports are available on the relationship between developmental orthopaedic diseases (DOD) and future performances in Warmblood horses. OBJECTIVES: To investigate the relationship between performance and the presence of DOD lesions. METHODS: Records of Warmblood stallions for which radiographic and performance data were available were collected. Showjumping performances were expressed as scores derived from the final ranking of horses in each competition. These scores are available in an established performance database. The relationship between radiographic findings and both performance scores and number of performances was analysed using a linear regression model. RESULTS: Two hundred and fifteen horses met the inclusion criteria. There was no difference in either the number of performances or performance score between horses categorised as affected with DOD lesions (independent of joint location) compared with controls. Significantly lower numbers of performances were recorded for horses with osteochondral fragments (OCD) located at the dorsal aspect of the sagittal ridge of the metacarpo/metatarsophalangeal bone. No significant difference was found between horses affected with DOD lesions of the tarsocrural joint and controls. Horses with osteochondrosis of the lateral trochlear ridge of the femur had both significantly lower performance scores and numbers of performances compared with controls. CONCLUSION: This study demonstrated that specific DOD location and site within the joint have an influence on performance. Osteochondral fragments in the femoropatellar and at the dorsal aspect of the sagittal ridge of the metacarpo/metatarsophalangeal joint resulted in lowered performance. Fragmentation in the tarsocrural joint had no influence on performance. POTENTIAL RELEVANCE: The future athletic performance of Warmblood jumping horses may be limited as a result of OCD in the femoropatellar joint and to a certain extent the metacarpo/metatarsophalangeal joint.

Investigation of the best suture pattern to close a stuffed Christmas turkey.

Instructions on how to debone and stuff a turkey are available, but what is the best way to close it up? A randomised trial involving 15 turkeys was performed in order to evaluate skin disruption scores and cosmetic outcomes following the use of different suture patterns. Turkeys were deboned, stuffed and cooked according to guidelines of the US Department of Agriculture Food Safety and Inspection Services. After stuffing, they were randomly assigned to one of five closure groups: simple continuous Lembert; simple continuous Cushing; simple continuous Utrecht; simple continuous; or staples. Turkeys were cooked at 180 °C for two hours ensuring core temperature reached 75 °C. Suture line integrity was evaluated after removal of the sutures and the cosmetic aspect was graded. Before cooking, the Utrecht pattern and skin staples offered the best cosmetic result. After removal of the sutures, the skin remained intact only in the stapled group. All other suture patterns disrupted the skin after removal of the sutures, rendering the turkey less cosmetically appealing for serving. Closure of a stuffed turkey was best performed using skin staples to achieve the best cosmetic results. Using this technique you will be able to impress family and friends at a Christmas dinner, and finally show them your surgical skills.

Theoretical discrepancy between cage size and efficient tibial tuberosity advancement in dogs treated for cranial cruciate ligament rupture.

OBJECTIVES: To calculate the difference between the desired tibial tuberosity advancement (TTA) along the tibial plateau axis and the advancement truly achieved in that direction when cage size has been determined using the method of Montavon and colleagues. To measure the effect of this difference on the final patellar tendon-tibial plateau angle (PTA) in relation to the ideal 90°. METHODS: Trigonometry was used to calculate the theoretical actual advancement of the tibial tuberosity in a direction parallel to the tibial plateau that would be achieved by the placement of a cage at the level of the tibial tuberosity in the osteotomy plane of the tibial crest. The same principle was used to calculate the size of the cage that would have been required to achieve the desired advancement. The effect of the difference between the desired advancement and the actual advancement achieved on the final PTA was calculated. RESULTS: For a given desired advancement, the greater the tibial plateau angle (TPA), the greater the difference between the desired advancement and the actual advancement achieved. The maximum discrepancy calculated was 5.8 mm for a 12 mm advancement in a case of extreme TPA (59°). When the TPA was less than 31°, the PTA was in the range of 90° to 95°. CLINICAL SIGNIFICANCE: A discrepancy does exist between the desired tibial tuberosity advancement and the actual advancement in a direction parallel to the TPA, when the tibial tuberosity is not translated proximally. Although this has an influence on the final PTA, further studies are warranted to evaluate whether this is clinically significant.

Radiographic features of the dorsal condylar sagittal ridge of the third metacarpal and metatarsal bones in young Warmblood stallions.

OBJECTIVES: To describe the radiographic appearance of the dorsoproximal aspect of the sagittal ridge of the third metacarpal/metatarsal bone in Warmblood horses. METHODS: The lateromedial radiographic projections of the metacarpo-/metatarsophalangeal joints performed on horses as a part of stallion selection were used. The dorsal aspect of the distal third metacarpal/metatarsal bone was divided in two areas. The appearance of the bone surface in area I was classified as normal, irregular, notch, indentation and lucency. For area II, the categories were normal, irregular, depression or lucency and flattening of the sagittal ridge. Other abnormalities at the dorsal aspect were also noted. RESULTS: In area I, 51.5% of the ridges appeared normal, 19.3% were irregular, 8.9% had a notch, 8.1% had a lucency, and 12.2% had an indentation. In 1.2% of the horses a fragment was present, and in 1.7% a fragment was suspected. In area II, 90.6% of the metacarpo-/metatarsophalangeal joints were normal, 6.2% were irregular, 2.9% showed a depression or lucency, and the sagittal ridge in 0.2% was flattened. A fragment was present in 0.3%, and suspected in 0.4%. CLINICAL SIGNIFICANCE: Morphological variation is present at the dorsal aspect of the metacarpo-/metatarsophalangeal joint in young Warmblood stallions. These various aspects should be recognised and described in horses presented for prepurchase examination. However, their clinical relevance in the individual horse is unclear and needs further investigation.

Progressive juvenile glomerulonephropathy in 16 related French Mastiff (Bordeaux) dogs.

BACKGROUND: Familial juvenile glomerulonephropathy (JGN) is reported in several breeds of dogs. The mode of inheritance and spectrum of pathological lesions vary among breeds. A progressive JGN was detected in a pedigree of French Mastiff (FM) dogs. OBJECTIVES: To describe clinical, laboratory, and histopathologic findings in related FM dogs suffering from progressive JGN and to determine the mode of inheritance of this condition. ANIMALS: Sixteen affected and 35 healthy related FM dogs METHODS: FM dogs < 24 months of age and diagnosed with chronic kidney disease with evidence of proteinuria entered the study. Clinical, laboratory, histopathologic findings, and pedigree data were recorded. RESULTS: Clinical signs were typical of progressive glomerulopathy with resultant renal failure. Increased blood urea nitrogen, creatinine and total cholesterol concentrations, and proteinuria were found in all patients. Affected dogs had abnormal kidney structure on abdominal ultrasound examination. Histopathologic examination revealed extensive cystic glomerular atrophy, glomerular hypercellularity, and capillary wall thickening without immune complex deposition when tested with immunohistochemistry or immunofluorescence. Electron microscopy did not disclose specific primary glomerular lesions. Mean age at death was 20 months and mean length of survival after diagnosis was 6 months. Both males and females from healthy parents were affected. An autosomal recessive mode of transmission is suspected, but a more complex mode of inheritance cannot be excluded. CONCLUSIONS AND CLINICAL IMPORTANCE: Progressive familial JGN occurs in FM dogs. Characterization of the pathogenesis and mode of inheritance of this disease warrants additional study.

Variations of plasmatic concentrations of Insulin-like Growth Factor-I in post-pubescent horses affected with developmental osteochondral lesions.

Developmental osteochondral lesions are often encountered in the equine population and are a major cause of lameness. Different growth factors that act systemically as well as locally regulate the growth of cartilage. Among them is Insulin-like Growth Factor I that has been demonstrated to promote chondrocyte growth and differentiation and that has been shown to influence cartilage repair. The aims of this study were to investigate differences in circulating plasma levels of Insulin-like Growth Factor-I in post-pubescent horses affected with developmental osteochondral lesions compared to unaffected ones. Significantly higher values of circulating Insulin-like Growth Factor-I levels were found in the affected group (n = 82) compared to controls (n = 86). This result may still reflect an earlier imbalance in IGF-I levels from horses with developmental osteochondral lesions considering the aetiopathological link which has been made between IGF-I and the occurrence of osteochondrosis. However, other studies have shown increased expression of IGF-I after cartilage damage. The higher levels found in this study could be due to a healing response of the cartilage to the damage caused by the osteochondral lesions.

Differentiation of glycans in equine guttural pouches.

The aim of this study was to investigate the carbohydrate composition of mucosubstances in the equine guttural pouches using conventional histochemical tests in conjunction with glycolytic digestion to degrade different classes of glycosoaminoglycans. In the goblet cells, the mucopolysaccharides contained chondroitin sulfate B, heparin, heparan sulfate and sialic acid residues. The acinar cells also expressed these substances (except for heparin), whereas the ductal cells produced chondroitin sulfate B and sialic acid. Neutral sugars were also found in each cell type. The diversity of the glycocomponents found in the auditory tube suggests that they may have important functional roles. Indeed, the glycosoaminoglycans provide a hydrophilic environment that prevents dehydration and desiccation of the guttural membranes during air passage. Additionally, these glycomolecules may be involved in the pathogenesis of some bacterial disease in horses, such as equine strangles.

Effect of instillation into lung of autologous blood on pulmonary function and tracheobronchial wash cytology.

This study aimed at measuring the functional consequences and the pulmonary cytology changes following a simulation of pulmonary haemorrhage. Pulmonary function tests including lobeline-induced hyperventilation, cytology of tracheo-bronchial wash (TBW) and thoracic radiographs were performed before, as well as 1, 7, 14 and 28 days after, the instillation of 300 ml of blood into the lungs of 4 horses deemed free of exercise-induced pulmonary haemorrhage (Group 1). Control data (Group 2) were obtained by instilling the same volume of saline into the lungs of the same horses in a crossover design (control). The instillation of blood or saline resulted in an increase in the number of neutrophils in the TBW. Thoracic radiographs showed increased opacity in the caudodorsal region of the lungs in 4/4 (Day 1) and 2/4 horses (Day 7), in Group 1, and in 2/4 (Day 1) and 0/4 horses (Day 7) in the control group. These changes were attributed to the instillation procedure rather than the nature of the instilled material. Breathing mechanics and arterial blood gases at rest were not affected in either Groups 1 or 2. However, the maximal expiratory peak flow recorded during lobeline-induced hyperventilation was significantly lower (P<0.05) and the total pulmonary resistance significantly higher (P<0.05) on Day 1 in Group 1, but not Group 2. These observations suggest that expiratory flows might be partly limited in bleeders when breathing at high airflow.

Ultrasonography of the podotrochlear apparatus in the horse using a transcuneal approach: technique and reference images.

The purpose of this paper is to describe the technique for ultrasonographic examination of the podotrochlear apparatus in the horse using a transcuneal approach. In this study, ultrasound scans were performed in 3 normal cadaver limbs and 5 sound horses and images were compared to anatomic sections to establish the normal ultrasonographic anatomy of the podotrochlear apparatus. Detailed description of transverse and sagittal reference ultrasonographic images of this region is provided. This new imaging technique allows the assessment of the distal sesamoid bone flexor surface, the distal portion of the deep digital flexor tendon, the impar distal sesamoidean ligament, and the entheses of the distal phalanx.

Ultrasonographic anatomy of the accessory ligament of the superficial digital flexor tendon in horses.

The ultrasonographic anatomy of the accessory ligament of the superficial digital flexor tendon (AL-SDFT) in the horse is presented. Comparison between anatomical sections of isolated limbs and ultrasound scans of the distal antebrachium in sound horses enabled the authors to establish the normal reference ultrasonographic images of this structure. The AL-SDFT inserts 7-14 cm above the antebrachiocarpal joint on the palmaromedial aspect of the radius. Ultrasonographically it appears as an uniformly echogenic structure located deep to the median artery. The knowledge of ultrasonographic anatomy is essential for identification of abnormal images and assessment of AL-SDFT damage.

Ultrasonographic examination of the proximal scutum in the horse.

Normal and abnormal ultrasonographic images are presented of the proximal scutum (proximal sesamoid bones and palmar ligament) in the horse. Comparison between anatomical sections, MRI (magnetic resonance imaging) and ultrasound scans enabled the authors to establish the normal ultrasonographic anatomy of the palmar fetlock. Nine cases of proximal scutum injuries were identified ultrasonographically, of which 4 are illustrated. On normal limbs, the facies flexoria of the proximal sesamoid bones appeared as a thin and regular hyperechoic line and the palmar ligament was regularly echogenic. Lesions of the proximal scutum, that could be documented ultrasonographically, included rupture of the palmar ligament, avulsion fractures of the proximal sesamoid bones and palmar ligament desmopathy. Thinning or degeneration of the palmar ligament, concurrent with osteolysis of the proximal sesamoid bones, were indicative of palmar ligament enthesopathy. Ultrasonographic examination provided essential information for an accurate diagnosis of proximal scutum damage.