Metabolic bone disease in juvenile koalas (Phascolartcos cinereus).

Due to climate restrictions in parts of North America and Europe, koalas (Phascolarctos cinereus) are housed indoors. Koala young (joeys) raised indoors are susceptible to the development of metabolic bone disease (MBD) due to a lack of exposure to natural ultraviolet light to themselves and their female parents (dams). In this retrospective study, radiographs from 27 koala joeys born at four zoos in North America and two zoos in Europe were evaluated for signs of MBD. Eight of the joeys were radiographically diagnosed with MBD and four additional joeys were considered suspect MBD cases; in two joeys absence or presence of MBD could not be determined. All joeys had mild to severe hip and shoulder dysplasia. There were significant associations between a lack of exposure to UV light and MBD development and between MBD and the degree of severity of hip and shoulder dysplasia. It is recommended to house breeding female koalas and their joeys outdoors whenever possible.

Defining the rate of, and factors influencing, radiographic progression of osteoarthritis of the canine hip joint.

BACKGROUND: This study aimed to define the rate of progression of radiographic osteoarthritis (OA) of the canine hip joint and to describe factors affecting this progression. METHODS: Dogs that underwent unilateral total hip replacement (THR) were reviewed for the evaluation of radiographic appearance of the non-operated hip joint over time. Standard extended ventrodorsal hip radiographs were taken preoperatively and postoperatively. All images were anonymized, randomized and scored using three different methods. The mean daily change between evaluations was calculated in each individual dog, and the effect of sex, age, body weight, open/closed status of the proximal femoral physis, preoperative severity of OA, time after surgery and their interactions, were investigated as potential influencing factors. RESULTS: After reviewing the medical records, 163 dogs (468 images) met the inclusion criteria. Consistent across the three scoring systems, radiographic progression of OA was greater in younger (open physis) and spayed female dogs. A subset of seven patients (4.3%) had a faster progression of OA and was considered outliers. No dog was rated as outlier by all three scoring systems. CONCLUSION: The rate of progression of radiographically assessed coxofemoral OA varies greatly, but is faster in younger, spayed female dogs. Unusually fast progression occasionally occurs.

Improving service delivery by evaluation of the referral pattern and capacity in a clinical genetics setting.

Quality improvement in specialist services such as clinical genetics is challenging largely due to the complexity of the service and the difficulty in obtaining accurate, reproducible, and measurable data. The objectives were to evaluate the pattern of referrals to the All Wales Medical Genetics Service (AWMGS) North Wales Genetics team based in three separate hospitals, define the capacity of the team and implement change to improve equity, timeliness and efficiency of care delivery to patients. The methodology required collating the monthly referral rates retrospectively for each center over a 2.5-year period and plotting on statistical process control charts. Process mapping of the referral process in each center was undertaken, differences documented and a common pathway implemented. "Did not attend" and "time to first appointment" rates were also measured in one center. PDSA methodology was used to implement "patient focused booking." The results show that the range for referral rates in any given month for each center was 3-33 referrals. The range for referral rate for the whole team was 18-64 per month. Since January 2004 the average number of monthly referrals to the North Wales service has increased by 50%. The potential range in monthly referrals varies between centers and the range of the variability has also increased also in two out of the three centers. Introduction of Patient Focused Booking reduced the "Failed to Attend" rate and 100% of patients were offered a choice of appointments. In addition 100% had a first face-to-face contact within 6 weeks if they chose. The measurement of improvement involved firstly introducing a series of continuous measures to provide a baseline for the process prior to the implementation of any changes and secondly to indicate the impact of the changes following implementation. The measures implemented included process (referrals numbers, percentage of patients offered a choice of appointments), outcome (percentage of patients seen within 6 weeks and the percentage failing to attend), and balancing measures (percentage declining the service or failing to respond). It was concluded that general tools of quality improvement can be used to good effect within specialist services. Good processes and accurate, reproducible and measurable data are essential. Small changes can have a major impact both on the quality of the service offered and the ability to deliver the service.

Does changing the orientation of a thoracic radiograph aid diagnosis of rib fractures?

To test the hypothesis that changing the orientation of a thoracic radiograph aids diagnosis of rib fractures, a case-control study was carried out using 120 radiographs of small animal patients with recent thoracic trauma. Six independent observers representing three levels of experience viewed the radiographs in randomized order in conventional and unconventional orientations at 15-s intervals in a PowerPoint presentation. Sensitivity for rib fractures was 53-69% and specificity was 74-97%, depending on the observer. Radiologists had higher specificity than less experienced observers (P = 0.0001), but comparable sensitivity for rib fractures. Radiologists had significantly higher accuracy than residents (P = 0.03), and residents had higher accuracy than interns (P = 0.02). Accuracy of diagnosis was reduced significantly when based on lateral radiographs compared with dorsoventral (DV)/ventrodorsal (VD) views (P = 0.02) mainly because of low sensitivity of lateral radiographs of dogs with rib fractures. Rotating radiographs 90 degrees clockwise was associated with increased specificity of one intern (from 74 to 90%, P = 0.03), but had no effect on accuracy of diagnosis by other observers (P > 0.16). Turning DV/VD views upside down had no effect on accuracy of diagnosis of any observers (P > 0.40). Changing the orientation of a thoracic radiograph may make it easier for some novices to examine the ribs; hence it could be considered a training aid rather than a technique that will benefit an experienced radiologist.

Radiographic definition of the anticlinal vertebra in the dog.

The anticlinal vertebra is a point in the caudal thoracic vertebral column at which vertebral anatomic features change. It may be used as a point of reference in diagnostic imaging studies. However, its exact definition and anatomic location are not consistent between anatomic texts. The position of the anticlinal vertebra was evaluated radiographically in 100 dogs, using three different definitions of the anticlinal vertebra. Definition P referred to perpendicularity of the spinous proceses, definition V referred to verticality of the spinous processes, and definition J referred to the orientation of the intervertebral joints. The anticlinal vertebra was assessed to be T11 in 85%, 75%, and 89% of dogs for definitions P, V, and J, respectively. Combining definitions improved the likelihood that the vertebra assessed to be the anticlinal vertebra was T11, if the combination included definition J, but at the expense of loss of sensitivity. The degree of agreement between the definitions ranged from fair to poor. The level of agreement between definitions P and J was improved for small and large dogs and the level of agreement between definitions V and J was improved for medium and large dogs. Compared with large breed dogs, small breed dogs were more likely to have T10 described as the anticlinal vertebra. The presence of transitional vertebra did not affect the position of the anticlinal vertebra. It should not be assumed that the anticlinal vertebra is T11 in all dogs. Care should be taken to define this anatomic feature accurately when using it as an anatomic landmark.

High serum troponin I concentration as a marker of severe myocardial damage in a case of suspected exertional heatstroke in a dog.

A young, overweight dog presented with sudden onset lethargy and collapse following exercise in warm environmental conditions. Investigations revealed systolic hypotension, multiform ventricular premature complexes, irregular myocardial echogenicity with poor left ventricular systolic function and a markedly elevated troponin cTnI (180ng/mL, reference range <0.3ng/mL) consistent with severe myocyte damage. Infectious causes of myocarditis were ruled out on the basis of serological and polymerase chain reaction blood tests. Exercise-induced malignant hyperthermia was excluded from the history, an exercise tolerance test and genetic testing for the RYR1 V547A mutation. The diagnosis was myocardial damage secondary to suspected exertional heatstroke, from which the dog recovered uneventfully over a number of weeks and serum troponin normalised. This is the first case report in any species including man, documenting high troponin as a marker of severe myocardial damage following suspected heatstroke.