Cone-Beam Computed Tomography (CBCT) dacryocystography for imaging of the nasolacrimal duct system.

PURPOSE: To evaluate the usefulness and safety of cone-beam computed tomography (CBCT) dacryocystography in detecting lesions, identifying coexisting soft-tissue changes and determining treatment options in patients with epiphora. PATIENTS AND METHODS: Unilateral digital subtraction dacryocystography and CBCT dacryocystography were carried out on 45 patients. Stenoses and occlusions were identified and coexisting changes such as septal deviation and dacryoliths were noted. The diameter of the bony lacrimal duct of affected and unaffected side was measured and related to the clinically evident epiphora. An attempt was made to base the subsequent therapeutic planning on the CBCT dacryocystographic findings. Additionally, the radiation dose levels for CBCT dacryocystography in comparison to those of multislice computed tomography (MSCT) were evaluated in a standardized head-neck Rando-Alderson phantom. RESULTS: Nasolacrimal duct obstructions were present in 37/45 patients, 18 with a stenosis and 19 with an occlusion in parts of the lacrimal outflow system. The minimal bony diameter of the side with epiphora was significantly decreased compared to the unaffected side. Coexisting soft-tissue changes did not correlate significantly with the clinical sign of epiphora. Eight patients showed no underlying reason for the epiphora and were treated conservatively. A total of eleven patients received interventional therapy for their stenosis and 23 patients had to be treated surgically. A further three patients received medical treatment for infection, before surgery and interventional therapy, respectively, were carried out. Dose levels for CBCT imaging remained far below those of MSCT. CONCLUSION: CBCT dacryocystography is a safe and time-efficient modality for assessing the nasolacrimal duct system in patients with epiphora. CBCT dacryocystography provides detailed images of the nasolacrimal drainage system, surrounding soft tissue, and bony structures in one diagnostic tour. It allows clear measurement of the bony nasolacrimal duct and displays information beyond that of the drainage lumen, improving the planning of therapeutic interventional and surgical procedures.

Ex vivo MRI cell tracking of autologous mesenchymal stromal cells in an ovine osteochondral defect model.

BACKGROUND: Osteochondral injuries represent a significant clinical problem requiring novel cell-based therapies to restore function of the damaged joint with the use of mesenchymal stromal cells (MSCs) leading research efforts. Pre-clinical studies are fundamental in translating such therapies; however, technologies to minimally invasively assess in vivo cell fate are currently limited. We investigate the potential of a MRI- (magnetic resonance imaging) and superparamagnetic iron oxide nanoparticle (SPION)-based technique to monitor cellular bio-distribution in an ovine osteochondral model of acute and chronic injuries. METHODS: MSCs were isolated, expanded and labelled with Nanomag, a 250-nm SPION, and using a novel cell-penetrating technique, glycosaminoglycan-binding enhanced transduction (GET). MRI visibility thresholds, cellular toxicity and differentiation potential post-labelling were assessed in vitro. A single osteochondral defect was created in the medial femoral condyle in the left knee joint of each sheep with the contralateral joint serving as the control. Cells, either GET-Nanomag labelled or unlabelled, were delivered 1 week or 4.5 weeks later. Sheep were sacrificed 7 days post implantation and immediately MR imaged using a 0.2-T MRI scanner and validated on a 3-T MRI scanner prior to histological evaluation. RESULTS: MRI data demonstrated a significant increase in MRI contrast as a result of GET-Nanomag labelling whilst cell viability, proliferation and differentiation capabilities were not affected. MRI results revealed evidence of implanted cells within the synovial joint of the injured leg of the chronic model only with no signs of cell localisation to the defect site in either model. This was validated histologically determining the location of implanted cells in the synovium. Evidence of engulfment of Nanomag-labelled cells by leukocytes is observed in the injured legs of the chronic model only. Finally, serum c-reactive protein (CRP) levels were measured by ELISA with no obvious increase in CRP levels observed as a result of P21-8R:Nanomag delivery. CONCLUSION: This study has the potential to be a powerful translational tool with great implications in the clinical translation of stem cell-based therapies. Further, we have demonstrated the ability to obtain information linked to key biological events occurring post implantation, essential in designing therapies and selecting pre-clinical models.

Detection of coronary arteries and evaluation of anastomoses with a commercially available 15-MHz, broadband, linear array transducer.

BACKGROUND: In coronary artery bypass surgery the detection of the target vessels can be difficult due to their intramural location, coverage by adipose tissue, calcification, or fibrous tissue formation. Their identification is especially critical during off-pump coronary artery bypass (OPCAB) and minimally invasive direct coronary artery bypass (MIDCAB) surgeries. Our objectives were to identify whether (1) the epimyocardial use of the broadband linear array transducer CL15-7 allows a clear and rapid identification of the target artery during on-pump coronary bypass (CPB), OPCAB and MIDCAB surgeries; and (2) if this transducer is helpful in investigating the anastomotic morphology with 2D and color flow Doppler. METHODS: Thirty-two patients without a visually identifiable left anterior descending artery (LAD) were included in the study and epimyocardial ultrasonography was performed. Stabilization of the beating heart was used in 19 patients; in 13 patients, the surgery was carried out with CPB on the arrested heart. Two-dimensional ultrasound alone, or in combination with color Doppler, was used to identify the affected vessel as well as a suitable anastomosis site. Pulsed wave Doppler had to be used occasionally to differentiate between artery and vein. Patency of the anastomoses was established with color Doppler immediately after reinitiating blood flow. An evaluation of the distal graft diameter, its length, and the quality of the anastomosis was made with 2D and color Doppler. Transit-time Doppler flow was used to confirm patency. RESULTS: The LAD could be identified ultrasonographically in all 32 patients at a depth of 3 to 15 mm. The right coronary artery (RCA) was located at a depth of 3 to 10 mm in the 5 patients where this vessel was to be bypassed. The coronary arteries located on the lateral or posterior aspect of the heart could not be reached due to the shape and rigidity of the transducer handle. The intended anastomosis sites of the LAD and RCA were identified with ultrasound according to their topography and morphology. In all cases the vessel could be dissected and bypassed without undue damage or bleeding. In one OPCAB patient, the LAD was identified in close proximity to the overlying vein along the whole of the anterior wall. This resulted in conversion to CPB, thus facilitating secure exposure of the LAD. The ultrasonographic visibility of the left internal mammary artery to LAD and saphenous vein graft to RCA anastomoses was excellent, and patency correlated well with the transit time flow measurements. CONCLUSION: The CL15-7 transducer gives excellent near field visibility of the LAD and RCA. This is extremely valuable for the safe dissection of these vessels, especially during off-pump coronary surgery. The anatomical morphology of the anastomoses can be identified but, due to the shape of the transducer handle, only the coronary arteries on the anterior surface of the heart can be evaluated. A flexible, rather than a rigid, hockey stick-shaped handle would eliminate this problem. Training is essential to obtain reliable results.

MR-imaging of lumbosacral intervertebral disc degeneration in clinically sound German shepherd dogs compared to other breeds.

German shepherd dogs are overrepresented in the group of dogs with cauda equina compression syndrome due to degenerative lumbosacral stenosis. A congenital predisposition for early degeneration of the lumbosacral intervertebral disc has been suspected. Our aims were to assess the morphologic appearance of the lumbosacral intervertebral disc and the lumbosacral junction in healthy German shepherd dogs compared to other breeds and to evaluate for an early onset of degenerative changes. The lumbosacral spine of 110 clinically sound German shepherd dogs and 47 healthy dogs of other large breeds was examined using magnetic resonance (MR) imaging. The degeneration of every intervertebral disc was graded using an established classification system. Signal intensity of the entire lumbosacral disc and the nucleus pulposus was determined independently. Lumbosacral malalignment was assessed according to a previously described method. The findings for the German shepherd dogs were compared to those of the other breeds. Although most dogs were younger than 18 months at the date of examination, significantly higher grades of degeneration were detected for the lumbosacral intervertebral disc of German shepherd dogs (P < 0.003). Degeneration of the lumbosacral intervertebral disc was independent from findings in the other lumbar discs. We conclude that the German shepherd dog has a predisposition for degenerative changes in the lumbosacral intervertebral disc.

Influence of femoral head and neck conformation on hip dysplasia in the German Shepherd dog.

We investigated the prevalence of an anatomic variant of the proximal femur, termed the broomstick-like femoral head and neck formation, and its influence on the Féderation Cynologique Internationale (FCI) hip dysplasia score in 294 German Shepherd dogs. One-hundred and eighty (61%) of the 294 dogs in our study had this anatomic variant. The calculated area of the femoral heads in dogs with a broomstick-like conformation was 4.5 +/- 0.6 cm2 on the hip-extended view. In dogs with a normal femoral head, the calculated area of the femoral head was significantly larger at 4.8 +/- 0.6 cm2 (P < 0.05). In the frog-leg view, there was no significant difference in femoral head area between dogs with the broomstick-like conformation and normal dogs. There was no difference in the antetorsion angle between dogs with broomstick-like conformation and normal dogs. There was also no difference in the distraction ratio between the two phenotypes. The official FCI hip score was similar in dogs with and without the broomstick-like conformation. The average heritability of the broomstick-like conformation was 0.3 +/- 0.1, suggesting heritable influence. We conclude that the broomstick-like conformation is a common finding in the German shepherd dog and has genetic base. The broomstick-like conformation does not appear to be associated with the presence of canine hip dysplasia and it can therefore be assumed to be a normal anatomic variant.

Ultrasonographic anatomy of abdominal lymph nodes in the normal cat.

Lymph nodes are essential structures to be evaluated in an ultrasonographic examination of the feline abdomen. It was hypothesized that current technical proficiency would allow all feline abdominal lymph nodes to be identified ultrasonographically. Ten clinically normal, adult, domestic shorthair cats were examined using real-time compound ultrasonographic imaging. The medial iliac lymph nodes were visible in 100% of the cats, the jejunal lymph nodes in 90%, the hepatic lymph nodes in 70%, the aortic lumbar, the splenic, and the pancreaticoduodenal lymph nodes in 60% each, the ileocecal and the colic lymph nodes in 50% each, and the renal, the gastric, the sacral and the caudal mesenteric lymph nodes in 40%, 30%, 20%, and 10% of the cats, respectively. The inconsistent presence of lymph nodes, their poor echocontrast and interposed gas of the gastrointestinal tract explain the lower percentages of identification. The ultrasonographic length and diameter of the lymph nodes were determined. The majority of these measurements corresponded to those in the literature. We conclude that ultrasonography is a valuable tool for the identification and evaluation of most abdominal lymph nodes in the normal cat. Average ultrasonographic measurements are presented as a preliminary guideline for normal feline abdominal lymph nodes. ete

Sutureless anastomoses of rabbit carotid arteries with BioGlue.

OBJECTIVE: Sutureless anastomoses for coronary artery surgery are being investigated for a minimally invasive setup because they are easy to perform and less time-consuming than are sutured anastomoses. The short-term effects of the biocompatible adhesive BioGlue on vascular tissue have been described as potentially unfavorable. The present study investigates the medium-term macroscopic and histologic effects associated with the use of BioGlue on rabbit carotid arteries. METHODS: Thirty-four carotid arteries of 17 New Zealand White rabbits were available. Nine carotid arteries were left unmanipulated and free of glue, 9 carotid arteries had BioGlue applied as a control, and 16 carotid arteries were transected and reanastomosed with the aid of BioGlue and an endovascular balloon. Of the 16 transected arteries, 4 had to be excluded from further evaluation. Angiographic scanning was performed 60 days postsurgery, after which the animals were euthanized and tissue samples were obtained for macroscopic and histologic examination. RESULTS: The application of BioGlue resulted in a marked invasion of inflammatory cells. The glue partially degraded and was replaced with connective tissue. Obvious calcification of the arterial wall and the capsule that had formed around the glue was present. Stenoses, thrombi, and pseudoaneurysms were predominantly noted in the glued anastomosis group. CONCLUSION: The results of this study raise concerns about the safety of BioGlue in coronary artery surgery. In light of our results, the use of BioGlue in large-vessel vascular surgery should be considered with great care for each individual patient.

Echolaryngography in cats.

Twenty-five cats with clinical signs of upper respiratory tract disease and five cats without upper respiratory signs underwent echolaryngography. Direct inspection of the larynx under general anesthesia was undertaken in all cats and used as the 'gold standard' for the diagnosis of laryngeal diseases. The aims were to: (a) establish which anatomic structures of the larynx are visible ultrasonographically in cats without upper respiratory tract disease, (b) establish which laryngeal abnormalities can be detected and accurately localised using ultrasonography and (c) evaluate in which conditions the technique may provide complementary information or an alternative method of investigation. The ultrasound investigation accurately indicated the presence and location of cysts and masses. Abnormal laryngeal movements were also detected, although it was difficult to confirm whether these were unilateral or bilateral. Vocal cord thickening was seen but the underlying cause could not be established with this technique.