Inpatient dermatology consultations in a tertiary care hospital in Spain: A retrospective study of 750 patients. / Interconsultas dermatológicas en pacientes hospitalizados en un hospital terciario en España: un estudio retrospectivo de 750 pacientes.

OBJECTIVE: Medical consultations are a healthcare task that is generally undervalued and understudied. The main objective of this study was to describe and analyse the consultations requested of dermatology departments and the aspects that are involve in resolving the consultations. PATIENTS AND METHODS: We conducted an observational retrospective study that collected the consultations for patients hospitalised over a period of 36 months. We analysed variables related to the management of patients and the quality of the care. RESULTS: The study included 750 patients with a mean age of 64.85 (±20.23) years. The medical departments requested the most consultations, mainly internal medicine departments (37.9%). The most common topic for the consultations was inflammatory dermatoses (36.2%). The most common individual diagnosis was drug rash (8.1%). CONCLUSIONS: Consultation activities have a significant impact on the management of hospitalised patients, resulting in improved quality of care and reduced healthcare costs. These activities are also of training value for resident physicians.

Lower urinary tract symptoms and obstructive sleep apnea syndrome: Urodynamic evolution before and after one year of treatment with continuous positive airway pressure. / Síntomas de tramo urinario inferior y síndrome de apnea obstructiva del sueño: evolución urodinámica antes y después de un año de tratamiento con presión continua positiva de la vía aérea.

OBJECTIVE: To report the clinical evolution and the urodynamic behaviour of several lower tract urinary symptoms in patients with obstructive sleep apnea syndrome before and after the treatment with continuous positive airway pressure (CPAP) devices. METHODS: A prospective study was performed; patients with recent diagnosis of sleep apnea confirmed by nocturnal sleep polygraphy and absence of medical urological past history. In order to discard important lower urinary tract conditions, urological examinations were previously performed. Urinary symptoms were evaluated using the IPSS and OAB-V8 validated questionnaires, three-day Bladder Diary and invasive urodynamic examinations with a gap of one year before and one year after using the CPAP. RESULTS: 84 urodynamic studies were carried out in 43 patients. The IPSS score decreased by 3.58 points. The OAB-V8 score decreased by 2.87 points. Nocturia episodes decreased to one per night. The percentage of patients with nocturnal polyuria went down to 26%. The bladder compliance significantly increased (97.39 vs 200.40ml/cm H2O). The presence of detrusor overactivity decreased from 11 (before CPAP) to 5 patients (after CPAP). CONCLUSION: The proper treatment with CPAP showed a statistical and clinical improvement of several LUTS with limited urodynamic modifications.

Adalimumab (tumor necrosis factor-blocker) reduces the expression of glial fibrillary acidic protein immunoreactivity increased by exogenous tumor necrosis factor alpha in an organotypic culture of porcine neuroretina.

PURPOSE: To determine if exogenous addition of tumor necrosis factor alpha (TNFα) exacerbates retinal reactive gliosis in an organotypic culture of porcine neuroretina and to evaluate if concomitant adalimumab, a TNF-blocker, diminishes it. METHODS: Porcine retinal explants from 20 eyeballs were cultured. Cultures with 100 pg/ml TNFα, 10 µg/ml adalimumab, 100 pg/ml TNFα plus 10 µg/ml adalimumab, or controls without additives were maintained for 9 days. Freshly detached retinas were processed in parallel. TNFα levels in control culture supernatants were quantified with enzyme-linked immunosorbent assay. Cryostat sections were doubly immunostained for glial fibrillary acidic protein (GFAP), a marker for reactive gliosis, and cellular retinaldehyde-binding protein (CRALBP), a marker for Müller cells. Sections were also labeled with the isolectin IB4, a label for microglia/macrophages. RESULTS: TNFα in control culture supernatants was detected only at day 1. Compared to the fresh neuroretinal samples, upregulation of GFAP and downregulation of CRALBP occurred during the 9 days of culture. Exogenous TNFα stimulated glial cells to upregulate GFAP and downregulate CRALBP immunoreactivity. TNFα-treated cultures also initiated the growth of gliotic membranes and underwent retinal disorganization. Adalimumab inhibited the spontaneous increases in GFAP and maintained CRALBP. In combination with TNFα, adalimumab reduced GFAP expression and conserved CRALBP, with only slight retinal disorganization. No appreciable changes in IB4 labeling were observed under the different culture conditions. CONCLUSIONS: In cultured porcine neuroretina, spontaneous reactive gliosis and retinal disorganization were exacerbated by exogenous TNFα. Adalimumab reduced spontaneous changes and those induced by TNFα. Therefore, inhibiting TNFα may represent a novel approach to controlling retinal fibrosis observed in some human diseases.

Sub-acute and chronic MRI findings in bilateral canine fibrotic contracture of the infraspinatus muscle.

A six-year-old, 30-kg female German pointer dog was presented for examination with a history of pre-existing right-forelimb lameness and more recent (3 months) persistent lameness in the left-forelimb. Physical examination revealed mild left-forelimb lameness and a mild circumduction movement. There were no signs of pain or crepitation detected during manipulation of the shoulders, but the animal was unable to fully flex both glenohumeral joints. Magnetic resonance imaging, using fast recovery fast spin echo T2-weighted and fat saturated proton density sequences, revealed abnormal heterogeneous hypointensity in the right infraspinatus muscle and a heterogeneous hyperintense area in the left infraspinatus muscle. Surgical treatment consisting of a bilateral infraspinatus tenectomy resulted in improved limb function. Histopathological examination demonstrated tissue changes in the right infraspinatus, characterised by myofibre degeneration and fibrosis, compatible with a chronic degenerative process, while changes in the left infraspinatus muscle were characterised by variable degrees of fibre degeneration, haemorrhage and interstitial oedema.

Contrast-enhanced dynamic magnetic resonance nephrography in healthy dogs.

Twenty-three healthy mixed-breed male adult dogs were examined using serial magnetic resonance (MR) renograms. The images were obtained using a dynamic gradient-echo, fast SPGR, T1-weighted sequence and low doses of gadolinium chelates (0.025 mmol/kg). Time-intensity curves were obtained to assess typical urinary excretion parameters, namely, time to vascular peak (TVP), time to vascular drop (TVD), time to glomerular peak (TGP), parenchymal phase length (PPL), gradient of parenchymal phase (GPP) and pattern of excretory segment. The mean TVP, TVD, TGP and PPL were 31.6±11.8, 43.4±11.2, 154.0±36.2 and 115.2±37.7s, respectively. The GPP was 24.1±8.6% of signal intensity per min. The excretory segment was concave in all cases, and at the end of the examination, 87.1% of kidneys had shown a reduction in signal intensity of 50%. This MR nephrography protocol can provide adequate time-intensity curve parameters for the urinary system of dogs, offers excellent anatomical detail, and represents an alternative to radionuclide nephrography.

Diagnosis, genetic control and preventive management of canine hip dysplasia: a review.

Despite expensive screening and breeding programmes, hip dysplasia (HD) continues to be one of the most common orthopaedic diseases in dogs. The vast majority of dogs afflicted with HD show minimal to no clinical signs, but it can also be a highly debilitating condition for both working and pet dogs. Hip joint laxity is considered a major risk factor for the development of degenerative joint disease and a definitive diagnosis is made if characteristic signs are evident on a ventrodorsal view of the pelvis. Early prediction of the condition can be made using stress radiographic techniques to evaluate the passive hip laxity. The diagnosis of HD may be used for the purpose of selecting breeding stock or to decide on the best treatment approach. Breeding programmes based on individual dog phenotypes have been ineffective and a selection procedure based on breeding value (BV) estimation is recommended. Traditional conservative and surgical treatment approaches are reserved for dogs with overt clinical signs of the disease but such treatments can be expensive and aggressive, and are often ineffective in eliminating clinical signs or subluxation and in preventing the development of degenerative joint disease. The implementation of breeding programmes based on BVs and further research into early prediction/diagnosis of HD and effective preventive treatment approaches are essential.

[Treatment of an abdominal aorta aneurysms with endovascular stent grafts and embolizing materials: an experimental study]. / Tratamiento de un aneurisma de aorta abdominal con prótesis endovascular y materiales embolizantes: estudio experimental.

OBJECTIVE: To create an animal model to stabilize the aneurysmal sac and prevent type II leaks in the endovascular treatment of aneurysms of the abdominal aorta (AAA) by placing an endoprosthesis (stent-graft) and filling the aneurysmal sac. MATERIAL AND METHODS: AAA were experimentally induced in pigs and sheep; AAA were subsequently treated with endovascular stent grafts and stabilized in the same procedure by introducing ethibloc and onyx through a vascular catheter placed within the aneurysmal sac. All animals underwent aortography, and MR angiography and abdominal CT were performed on randomly selected animals. Histological studies included both macroscopic and microscopic examination. Two sheep were analyzed one year after the procedure. We evaluated the characteristics of the materials employed, their diffusion in the collateral arteries, and their efficacy in stabilizing the aneurysmal sac. RESULTS: The procedure was successfully carried out in all animals. Survival in the pigs was 100 %, whereas greater instability under anesthesia in the sheep led to 50 % perioperative mortality. Both ethibloc and onyx were considered easy to use and stable over time. CONCLUSION: The sac of an AAA treated with an endovascular stent graft and its collateral vessels can be treated in the same procedure with materials introduced through a catheter.

Hip dysplasia in Estrela mountain dogs: prevalence and genetic trends 1991-2005.

Three hundred and thirteen Estrela mountain dogs were examined for hip dysplasia (HD) using the standard ventrodorsal hip extended view, and graded into five categories (A, B, C, D and E) using the Fédération Cynologique Internationale's (FCI) scoring system. The Ortolani method was performed to evaluate hip joint laxity. Pedigree information was obtained from the Portuguese Kennel Club and the genetic trend was evaluated by calculating the mean breeding values (BVs) for the last 15 years, using the threshold model. HD was found in 66% of the dogs. There was low-moderate correlation between the results of the Ortolani test and FCI hip scores (r(s)=0.386; P<0.001). Grades of hip dysplasia were equal in both males and females (P=0.14) and in the animals' right and left sides (P=0.51). The mean BVs for HD were stable in dogs born between 1991 and 2003, and showed an improvement in 2004 and 2005. The data confirm the high prevalence and severity of HD in predisposed breeds that do not have breeding programmes in place. It also confirms an initial favourable change in BVs that is a likely consequence of the voluntary radiographic hip-screening programme.

Early hip laxity examination in predicting moderate and severe hip dysplasia in Estrela mountain dog.

OBJECTIVES: To determine the reliability of early passive hip laxity examination in predicting moderate and severe hip dysplasia. METHODS: The passive hip laxity of 104 Estrela Mountain dogs was evaluated using the Ortolani method, conventional hip-extended radiography and the PennHIP method, when the animals were between four and 12 months of age. After the age of one, dogs were re-examined for hip dysplasia using the Fédération Cynologique Internationale scoring system. The passive hip laxity results were subsequently compared with the Fédération Cynologique Internationale scores for sensitivity, specificity, positive predictive value, negative predictive value and accuracy. RESULTS: The PennHIP method achieved the best results in specificity (93 per cent), positive predictive value (91 per cent) and accuracy (88 per cent), and the Ortolani method was the best in sensitivity (92 per cent) and negative predictive value (92 per cent). CLINICAL SIGNIFICANCE: The Fédération Cynologique Internationale grades D and E can be predicted with confidence even before animals are one year old.

Mechanical devices to help in PennHIP examination.

A modified PennHIP procedure (MPP), using specific mechanical holding devices, was used on 70 dogs and compared to the standard PennHIP method (SPM) used on 39 dogs, in terms of technical effectiveness and the mean number of essential individuals within the X-ray room (EIXRR). The data using the Chi-squared test were consistent with the null hypothesis that the technical effectiveness was equal in the groups under investigation (P > 0.05). On the contrary, using the two-sample unpaired t-test the null hypothesis, that the mean EIXRR was equal, was rejected (P < 0.001). The estimated EIXRR was 3.4 +/- 0.7 and 5.7 +/- 1.2 (mean +/- SD) for MPP and SPM, respectively. In conclusion, the MPP needs fewer EIXXR than the SPM and complies with the new recommendations in X-ray protection, which introduce the ALARA (as-low-as-reasonably-achievable) idea.

Measurement of the femoral neck anteversion angle in the dog using computed tomography.

Simple and accurate limb and pelvic conformation evaluation using computed tomography (CT) can be useful in planning canine hip dysplasia (CHD) treatment and in helping to understand the pathogenesis of osteoarthritis and CHD. The objectives of this study were to describe a new method for femoral neck anteversion angle (FNA-angle) measurement in CT, and to compare it to the established radiographic standard biplanar method. The hips of 23 Estrela Mountain Dogs were evaluated using radiography and CT and their FNA-angles were determined by performing two CT examinations and with one radiographic measurement session. The intra-class correlation coefficient (ICC) was used to evaluate the repeatability (agreement between the two CT sessions, ICC=0.92) and reproducibility (agreement between each CT and radiographic session, ICC=0.91 in both cases) of the CT FNA-angle measurement method. This study suggests that CT FNA-angle measurement method is reliable and can be used in CT hip studies with confidence.

Repeatability and reproducibility of distraction indices in PennHIP examinations of the hip joint in dogs.

Repeatability and reproducibility of Distraction Index (DI) measurements in the PennHIP method were evaluated in 100 dogs. The PennHIP distraction views sent to the PennHIP Analysis Center (PAC) were duplicated, digitalised, and identified with a code, and an adequate computer software was used for DI measurements. One examiner performed two DI measurement sessions, evaluating individually 200 hip joints. The scoring repeatability and reproducibility were estimated calculating the Intraclass Correlation Coefficient (ICC) between the two DI measurement sessions and between the second DI measurement session and the DI in PAC reports, respectively. The ICC for repeatability was 0.97 [95% confidence interval (CI), 0.96 to 0.98], and the ICC for reproducibility was 0.95 (95% CI, 0.93 to 0.96). The results suggest that the DI measurement method described is repeatable and can reproduce the PAC reports with confidence. Distraction indices measured in different PennHIP studies, using this DI measurement method and performed by trained researchers, can be considered interchangeable.

Pitfalls in preparation of (3)H-unconjugated bilirubin by biosynthetic labeling from precursor (3)H-5-aminolevulinic acid in the dog.

We report problems encountered during preparation of tritium-labeled unconjugated bilirubin ((3)H-UCB) from precursor (3)H-5-aminolevulinic acid ((3)H-ALA) in 2 dogs with external biliary drainage installed into the animals under general anesthesia. Under prolonged sedation, 12.9 or 14.0 mCi of (3)H-ALA was administered intravenously in two divided doses, and bile was collected for 9 hours. In one animal, taurocholate (TC) infusion was needed to maintain bile flow. (3)H-UCB was isolated from the bile and recrystallized with the improved method of Webster et al (Webster CC, Tiribelli C, Ostrow JD. J Lab Clin Med 2001;137:370-3). Based on radioactivity and pigment content, hourly bile collections were pooled to optimize specific activities. Surprisingly, in the first dog, only 2.9% of injected radioactivity was recovered in bile and only 14.1% in urine, and the specific activities of the crystalline (3)H-UCB from the two pools were only 39.5 and 30.0 x 10(3) dpm/microg. High-performance liquid chromatography analysis revealed that only 4% of ALA degraded during 5 minutes in injection solution at pH 6.8. The low incorporation of (3)H-ALA and low specific activity of (3)H-UCB was apparently caused mainly by prior degradation and exchange of labile tritium of the (3)H-ALA and probably by enhanced endogenous ALA synthesis caused by the anesthetic/sedative agents. Revised procedures in the second dog improved the incorporation of (3)H-ALA to 11.9% excreted in bile and the specific activity of the crystalline (3)H-UCB to 122.0 and 50.8 x 10(3) dpm/microg, while urinary excretion of tritium increased to 28.5%. These experiences emphasize possible pitfalls in preparing (3)H-UCB by biosynthetic labeling from (3)H-ALA administered to dogs.

Diagnosis of renal agenesis in a beagle.

A case of right renal agenesis in a beagle, of interest because of the age of the dog at the time of diagnosis, is described. Physical, haematological, biochemical and urinary examinations, including measurement of endogenous creatinine clearance, were performed to assess renal function. Survey radiography, excretory urography, ultrasonography, computed tomography and nuclear magnetic resonance examinations were also used to confirm the absence of a kidney. The effect of kidney agenesis on renal function, evaluated on the basis of endogenous creatinine clearance, is discussed together with the benefits of the various imaging techniques to enable in vivo detection of renal abnormalities.

Transvenous coil embolization of an intrahepatic portosystemic shunt in a dog.

To treat an intrahepatic portosystemic shunt in a young dog, thrombogenic material was placed into the vessel lumen (transvenous coil embolization) under fluoroscopic control. One coil was placed into the shunt, followed one month later by two additional coils. Transvenous embolization may become a useful method in the treatment of some portosystemic shunts.

Magnetic resonance, computed tomographic and radiologic findings in a dog with discospondylitis.

Magnetic resonance (MR), computed tomographic and radiographic imaging were conducted in a dog with discospondylitis. The MR findings were increased T2 and decreased T1 signal intensity of the soft tissues ventral to vertebral bodies, the end plates of the same vertebral bodies and the intervertebral disc, and are similar to those described in human with discospondylitis.

Computed tomographic findings in ovine coenurosis.

Computed tomographic imaging was conducted in twenty ewes with cerebral coenurosis. CT imaging allowed precise evaluation of the size and location of the cyst, which appeared as a hypoattenuating structure with a mass effect. No meaningful correlation between clinical signs and the location of parasitic cyst was detected.

Coating titanium implants with bioglass and with hydroxyapatite. A comparative study in sheep.

This study compares the osteointegration of titanium implants coated with bioglass (Biovetro GSB formula) and with hydroxyapatite (HAP). Twenty-four bioglass-coated and 24 HAP-coated cylinders were implanted in the femoral diaphyses of sheep, and examined after 2, 4, 6, 8, 12, and 16 weeks. The HAP coating gave a stronger and earlier fixation to the bone than did bioglass. Bioglass formed a tissue interface which showed a macrophage reaction with little new bone formation activity. In contrast, HPA, showed intense new bone formation, with highly mineralised osseous trabeculae in the neighbourhood of the interface.