Haematogenous osteomyelitis: clinical presentation and outcome in three dogs.

Haematogenous osteomyelitis is a rare form of bone infection in adult dogs. Most commonly the infection is iatrogenic or traumatic in origin. The authors report three different presentations of haematogenous osteomyelitis: a focal pelvic localisation in a growing dog, a vertebral lesion in an adult dog with associated neurological signs and a multifocal affection in another adult dog with concomitant pathological fractures. Clinical signs included pyrexia of undetermined origin, focal pain and lameness. Diagnostic investigation included radiographic imaging, bone scintigraphy, magnetic resonance imaging, surgical biopsy, and bacteriological culture with sensitivity testing of biopsy specimens as well as of peripheral blood samples. Treatment consisted of long-term antimicrobial therapy and surgical debridement with curettage of the pelvic abscess of the young dog and decompressive hemilaminectomy of the second dog, with excellent recovery. The dog affected by polyostotic bone involvement and suffering pathological fractures was euthanatized. Haematogenous osteomyelitis may be a diagnostic and therapeutic challenge and may present as a devastating skeletal condition, even in adult dogs, and should be considered amongst the differential diagnoses early on to allow effective treatment.

Osmium zinc iodide reactive sites in the epidermal Langerhans cell.

Fixation of epidermis with a mixture of osmium tetroxide and zinc iodide (OsO(4)-ZnI(2)) for 24 hr renders the central periodic lamella of the Langerhans cell granule (LCG), the Golgi region, and the nuclear envelope of epidermal Langerhans cells preferentially visible. The use of this technique on Langerhans cells in normal epidermis and in epidermis of patients with histiocytosis (Letterer-Siwe disease) allows a broader visualization of the LCG's than was heretofore possible with routine glutaraldehyde-osmium tetroxide fixation and uranyl acetate-lead staining. The identical staining of Golgi apparatus and LCG favors the view that there is close relation between the Golgi area and the LCG's. Different staining characteristics of the LCG's near the Golgi region and at the cell periphery, respectively, may suggest that the LCG undergoes changes on its way from the Golgi area towards the extracellular space. The hypothesis is advanced that the material which is heavily impregnated with metal after fixation with OsO(4)-ZnI(2) might be a lipid.

Effects of autologous platelet rich plasma gel and calcium phosphate biomaterials on bone healing in an ulnar ostectomy model in dogs.

The aim of the study was to evaluate the bone healing properties of an osteopromotive platelet rich plasma (PRP) gel in combination with osteoconductive calcium phosphate (CaP) ceramic granules in a long-bone critical size defect in dogs. A standardised 2 cm long ulnar ostectomy was performed bilaterally in four dogs to compare new-bone formation by CaP matrix with and without association with PRP. Radiographic and histological evaluations were performed blindly. Radiographic evaluation was performed at three, six, nine, 12 and 16 weeks postoperatively. Quantitative measurements of new-bone formation were compared using statistical analysis. At explantation 16 weeks after surgery, no significant ossification was present, neither with CaP granules alone nor in association with PRP gel, and there was no difference of radiodensity between the groups. Qualitative histological evaluation demonstrated for both types of implants the presence of non-mineralised fibrous connective tissue around the CaP granules. New-bone formation was only present to a very small extent within the macropores of the CaP granules at the distal bone-implant interface. In our model which exhibited very limited osteoconduction, neither the CaP granules alone nor in association with PRP were sufficient to stimulate bone healing. In this canine model employing a critical size ulnar gap, the combination of CaP granules and PRP did not effectively promote bone regeneration.

Mycoplasma felis arthritis in two cats.

This report describes the occurrence of non-weightbearing lameness caused by Mycoplasma felis monoarthritis in two, immunocompetent, European, shorthair adult cats with a suspected history of trauma. Clinical signs recurred after conservative treatment. The joints were treated surgically and M felis was identified as the causative agent for the monoarthritis. Medication with 10 mg/kg doxycycline twice daily was initiated according to susceptibility testing. One cat underwent further joint flushing after two weeks; both the cats recovered completely after eight and nine weeks, respectively. The findings suggest that M felis, in addition to being an agent associated with conjunctivitis in cats, is able to act as a pathogen in other tissues and cause arthritis even in immunocompetent cats.

Immunohistochemical demonstration of immunoglobulin A in human sebaceous and sweat glands.

Immunoglobulin A (IgA) mediated humoral defense mechanisms have been detected on all mucous membrane surfaces. There are only a few papers about the presence of IgA in human skin. In order to demonstrate the occurrence of IgA in sebaceous and sweat glands, biopsies of normal human skin were investigated and compared to intestinal mucosa. Two different commercially available anti-IgA antibodies were used. For light microscopy peroxidase-anti-peroxidase (PAP) or avidin-biotin complex (ABC) staining was used, and for electron microscopy protein-A-gold (PAG) labeling was performed on tissue sections. Specifically decorated IgA was found in sebaceous glands as well as in various portions of eccrine glands. In sebaceous glands, the maximum of IgA concentration was seen near the mouth of pilosebaceous ducts. Sweat ducts exhibited a continuous coat of IgA, whereas secretory portions contained only singular scattered IgA positive cells. Immunoelectron microscopy suggests endocytotic uptake and processing of IgA in the glandular cells. These results indicate strongly that IgA are secreted by normal human sebaceous and sweat glands. Because it is well known that IgA plays an important role in inactivation of invading viruses, bacteria, and other antigenic structures on mucous membranes, it appears that IgA in sebum and sweat fulfil a similar function on the outer body surface.

Increases in circulating insulin-like growth factor I levels by the oral growth hormone secretagogue MK-0677 in the beagle are dependent upon pituitary mediation.

It has been well established that the spiroindoline sulfonamide MK-0677 stimulates GH secretion from the pituitary both in vitro and in vivo. MK-0677 has also been shown to increase serum insulin-like growth factor I (IGF-I) and cortisol levels in vivo; these increases are assumed to be driven by the increased serum GH and ACTH levels, respectively. However, such increases could also be due to a direct stimulatory action of MK-0677 at the level of the liver and adrenal cortex. To address this possibility, we investigated whether MK-0677 increased IGF-I and cortisol levels in hypophysectomized dogs. Baseline GH, IGF-I, and cortisol responses to MK-0677 (1 mg/kg, orally) were initially determined. Hypophysectomy (hypox; n = 7) or sham surgery (sham; n = 5) was then carried out. Six days postsurgery, the GH and cortisol responses to MK-0677 were reevaluated in each dog. In addition, each dog was treated with porcine GH (PST; 0.1 IU/kg, s.c.) to confirm the responsiveness of the GH-IGF-I axis. The mean peak GH increases in response to MK-0677 in the presham dogs (83.7 +/- 19.2 ng/ml), post-sham dogs (108 +/- 26.2 ng/ml), and pre-hypox dogs (121.2 +/- 13.6 ng/ml) were not significantly different. Mean peak GH levels were unchanged after MK-0677 administration in the hypox dogs (2.3 +/- 0.7 ng/ml). Before surgery, serum IGF-I levels increased to 243 +/- 27 and 224 +/- 47 ng/ml in the sham and hypox groups, respectively, after MK-0677 administration. Surgery was associated with a marked (> or =50%) decrease in serum IGF-I levels. MK-0677 administration increased IGF-I levels in the sham dogs from 78 +/- 14 to 187 +/- 31 ng/ml, whereas IGF-I levels remained unchanged (17.7 +/- 2.4 ng/ml) in the-hypox dogs. PST treatment increased IGF-I levels in the sham dogs from 162 +/- 30 to 325 +/- 32 ng/ml. In the hypox dogs PST treatment restored IGF-I to physiological levels (from 17.7 +/- 2.4 to 199 +/- 41 ng/ml). Cortisol was increased after MK-0677 administration 3.7-fold in the pre-sham, 3.6-fold in the post-sham, and 3.6-fold in the pre-hypox dogs, but no increase was seen in the post-hypox dogs. ACTH GEL administration (2.2 U/kg, i.m.) to hypox dogs returned cortisol to normal physiological levels, demonstrating the functional integrity of the adrenal cortex. This study demonstrates that the GH secretagogue MK-0677 does not directly stimulate an increase in serum IGF-I or cortisol levels, but depends upon the presence of an intact pituitary.

Simultaneous use of microfibrillar collagen hemostat and blood saving devices in a canine kidney perfusion model.

Intraoperative autotransfusion and topical microfibrillar collagen hemostats have been increasingly used, often simultaneously, in various surgical procedures to minimize intraoperative blood loss and thus reduce the inherent risks of homologous blood transfusion. As moderate amounts of small particles have been shown to pass through filtering devices during intraoperative autotransfusion, concern has been raised over the amount of heterologous collagen fibrils transfused and their effect on the host. We found that 2% of microfibrillar collagen hemostat particles pass through the 20-microns millipore filter contained in the tested autotransfusion device (William Harvey H-4700 cardiotomy reservoir). Using a canine kidney perfusion model, we found multifocal perivascular inflammatory reactions within the renal parenchyma five days after transfusion of filtered autologous blood containing minute amounts of microfibrillar collagen hemostat. The findings demonstrate a strong inflammatory foreign body response to heterologous collagen particles trapped in the microcirculation of the perfused kidneys. It is concluded that despite using filters with a pore size of 20 microns, using intraoperative autotransfusion and microfibrillar collagen hemostats simultaneously creates a potential risk because adverse reactions can be elicited especially within the microvasculature of tissues containing end-arterial circulation.

Transorbital approach to the porcine pituitary.

A transorbital approach to the pituitary gland is described in domestic swine weighing between 40 and 70 kg. A transpalpebral eye exenteration is performed and the optic canal is enlarged caudally, using a bone drill. An operating microscope is used to improve visualization of the surgical site as the pituitary stalk and anterior pituitary are exposed to the level of the optic chiasm. This approach exposes the pituitary sufficiently to perform either a hypophyseal stalk transection or a hypophysectomy or to implant cannulas for hypothalamic-hypophyseal portal blood sampling. This technique has been performed in more than 50 pigs without major complications. Postoperative recovery has been rapid and uneventful. The transorbital approach is a significant refinement of the frontal craniotomy and cerebral elevation technique previously described in the pig, and results in shortened surgery time, minimal brain manipulation, and greatly decreased morbidity.

Immunological changes in canine cruciate ligament rupture.

Samples of sera (39) and synovial fluid (36) from 58 dogs suffering from inflammatory arthropathy of the stifle joints, 47 of them in combination with unilateral or bilateral rupture of the anterior cruciate ligaments (CLR), were investigated for C1q-binding immune complexes (IC) using a solid phase radioimmunoassay. In 31 out of 39 sera (79 per cent) and 25 out of 36 synovial fluids (69 per cent) significant IC concentrations could be detected. As controls 21 healthy dogs were used. The radioimmunoassay was standardised with aggregated dog gamma globulin. The sera of the dogs were also investigated for anticollagen antibodies to denaturated type 1 or type 2 dog collagens. No evidence of the presence of these antibodies could be obtained. In a small percentage of sera and, or, synovial fluids rheumatoid factor could be demonstrated. These results indicate that the CLR in dogs is accompanied by immunological mechanisms.

Evaluation of immune complexes and collagen type-specific antibodies in sera and synovial fluids of horses with secondary osteoarthritis.

Thirty-one horses with secondary osteoarthritis as a sequel of trauma (chip fractures) or osteochondritis dissecans were screened for immune complexes (IC) and anticollagen antibodies. Eighty-two percent of horses with joint disease had circulating C1q-binding IC; 77% of those horses had IC in synovial fluids of affected joints. Although only a few horses had anticollagen type-II antibodies, anticollagen type-I antibodies were found in sera of 25% of the horses and in 41% of their synovial fluids. This correlated well with the clinical data and suggested that antibodies might have been elicited by antigens derived from detached intra-articular osteochondral fragments. Immunologic reactivity is a new concept in equine secondary osteoarthritis and might be involved in the mechanisms of chronic inflammation and progressive collagen destruction in degenerative joint disease.

Study of long-term survival after transsphenoidal hypophysectomy in clinically normal dogs.

Experimental hypophysectomies were performed in 7 clinically normal dogs, using a new modification of the transsphenoidal approach. This approach facilitated centering of the sphenoid bone trephination and allowed safe exposure of the hypophysis regardless of the size or shape of a dog's skull. Complications did not occur during surgery and all dogs recovered well from surgery. Growth hormone secretory capacity was measured over a 3-month period to assess completeness of hypophysectomies. One dog was euthanatized 2 months after surgery, 4 dogs were euthanatized at 3 months after surgery, and 2 dogs were allowed to survive and their progress was followed for 2.5 years. Soft palate dehiscence and keratoconjunctivitis sicca developed in 2 of the dogs. The technical deficiencies responsible for these complications were corrected shortly after the beginning of the study. In 4 of the 5 necropsied dogs, minute remnants of adenohypophyseal tissue were found in the sellae turcica. Measurement of in vivo growth hormone secretory capacity revealed that these remnants had an altered stage of functional activity. Although complete hypophysectomy was not achieved consistently, the main technical obstacle of hypophysectomy, the reliable identification and the avoidance of the vascular structures surrounding the hypophysis, has seemingly been overcome. The surgical technique proved to enhance the safety of hypophysectomy, and the procedure can be recommended to treat clinical cases of canine pituitary-dependent hyperadrenocorticism. The clinical significance of potential subtotal hypophysectomy remains yet to be evaluated.

Evaluation of craniotomy in dogs and cats.

Over a reporting period of 5 years, craniotomy was performed in 26 dogs and 5 cats with various intracranial lesions. X-ray computed tomography was performed in all animals prior to surgery. Twenty dogs and all cats had intracranial neoplasms; of these, 14 were meningioma, and 11 represented a wide variety of brain tumors and skeletal tumors. Three dogs were treated surgically for traumatic, open-skull fractures with cerebral damage, and 3 underwent biopsy to evaluate chronic inflammatory brain disease. The overall medium survival time was 212 days, the 1-year survival rate was 39%, and the 2-year survival rate was 20%. Dogs and cats with meningioma survived a mean 198 and 485 days, respectively, with 1-year survival rates of 30% for dogs and 50% for cats. The overall median survival time for animals with tumors other than meningeal intracranial neoplasms was 414 days, with a 1-year survival rate of 40%. The death of 19% of all animals could be related to the combination of advanced brain disease and surgery. Because fatality seldom occurred as a direct result of surgery, morbidity and mortality associated with craniotomy in pet animals can be seen as acceptably low. In 29 of 34 craniotomies, dura mater defects were left unsutured and no adverse effects were seen.

Macrohematuria and life-threatening anemia attributable to subepithelial vascular ectasia of the urinary bladder in a dog.

Hematuria leading to life-threatening anemia was evaluated in a 9-year-old male dog. At surgery, an abnormal vessel resembling an ulcerated varicose vein was found on the surface of the bladder mucosa. After removal of the lesion, hematuria ceased and had not recurred 22 months later.

Arteriovenous fistula of the jejunum associated with gastrointestinal hemorrhage in a dog.

Hemorrhage from the gastrointestinal tract of a young dog resulted in melena with concurrent anemia. Exploratory laparotomy revealed the hemorrhage originated from an arteriovenous fistula in the jejunum. Resection of the abnormal part of the jejunum was curative. The arteriovenous fistula in the dog was probably congenital in origin, but may have been the result of gastrointestinal tract trauma.

[Progress in medicine in individual presentations, XI. Modern forms of therapy in acne]. / Fortschritte der Medizin in Einzeldarstellungen, XI.

Several pathogenetic factors contribute to the development of acne vulgaris. These include genetic predisposition, hormonal influences, increasing sebaceous secretion, bacterial colonization of the follicle and keratinization defects in the follicular epithelium. Modern acne therapy can take specific forms on the basis of recent research on pathogenesis. Sebostatic therapy can be performed by the topical application of benzoyl peroxide or the systemic administration of hormones (oestrogens, antiandrogens). Local treatment with retinoic has proved optimal in achieving a comedolytic effect. Moreover, the long-term use of antibiotics--tetracyclines, erythromycin systemically or benzoyl peroxide topically--is beneficial in respect to a reduction in Propionibacterium acnes. Experiments with immunological therapy are still in the early stages. Optimum results are obtained by the rational combination of several therapeutic modalities adapted to the type of acne to be treated.

[Dysplastic nevus syndrome]. / Das dysplastische Nävussyndrom.

The dysplastic nevus (DN) was first described by Clark in 1976. It was subsequently recognized to be a precursor of melanoma. Dysplastic nevi present with typical clinical and histological criteria. The dysplastic nevus syndrome (DNS) can be considered when at least two other family members have been shown to have multiple dysplastic nevi. From our own experience of over 2000 non-selected patients with melanoma only 60 (3%) were shown to have the DNS. In these 60 we could prove direct genetic penetration even though no HLA phenotype preference could be seen. Evaluation of the biological activity of the DN in cell cultures, as well as T-lymphocyte analysis in the neighborhood of the DN have shown signs of incipient malignant transformation of the DN. The practical implications of these findings and observations are discussed.

[Economic aspects of serologic syphilis tests in routine screening in Viennese hospital facilities]. / Okonomische Aspekte der serologischen Syphilisteste im Routinebetrieb der Wiener Krankenanstalten.

971, 786 patients in Viennese municipal hospitals were routinely screened by serological testing for syphilis between January 1980 and December 1984, leading to the detection of 28,090 cases of untreated latent infection. The annual incidence varied between 7463 and 4623 cases. Roughly one third of patients with untreated syphilis develop severe late manifestations: 10.4% show cardiovascular involvement, 6.5% get neurosyphilis and 15.8% have a gumma. The mortality rate is 85% in cardiovascular disease and 64% in neurosyphilis, whilst irreversible incapacity is the fate of the remaining 15% and 36% of these patients, respectively. Calculations on the basis of the current costs for treatment of the acute diseased and for nursing of incapacitated patients reveal that routine screening of all in- and out-patients of the Viennese municipal hospitals is completely justified from the medical and the economic point of view and should, therefore, be reinforced.

[Prognosis in primary malignant melanoma based on histological assessment (a comparative study between two groups with different length of survival)]. / Zur histologischen Prognosestellung beim primären melanom (Vergleichsstudie zweier Kollektive mit verschiedenem Krankheitsverlauf)

In this retrospective study, sixty patients with primary malignant melanoma running a highly variable course (long- and short-term survivors) were reviewed histologically. In contrast to reports by other workers, a constant histological reaction pattern was selected, whereas the host reaction was the variable factor studied. In the majority of long-term survivors the tumour was surrounded by a dense lympho-histiocytic infiltrate, which was minimal or even absent in patients with a short-term survival rate. In the patients with long-term survival the peritumour connective tissue was definitely increased, whereas in the group in which the disease ran a short course there was destruction of peritumour connective tissue. The importance of these findings as an additional parameter for histological prognosis is discussed.

[The increase in skin melanomas in Austria (1926-1980)]. / Zur Zunahme der Hautmelanome in Osterreich (1926 bis 1980).

This statistical study demonstrates the increase in incidence of cutaneous malignant melanoma in Austria over the time period 1926 to 1980 and the changing pattern of tumour localization. The results of this study are discussed with reference to aetiology, especially of sunlight as a causative factor.

[Penicillamine-induced elastosis perforans serpiginosa and pulmonary cyst in Wilson's disease (author's transl)]. / Penicillamin-induzierte Elastosis perforans serpiginosa mit Lungenzyste bei Morbus Wilson.

A large air cyst was removed from the right lung of a 29-year-old female patient with Wilson's disease and penicillamine-induced perforating elastosis, the cyst first appearing after 9 years of treatment with penicillamine. Since, on the one hand, the microscopic and ultrastructural changes in the elastic tissue of the lungs were identical to those observed in the skin, both in areas of clinically-demonstrable elastosis perforans serpiginosa and clinically unaffected skin and, on the other hand, no other pulmonary disease was demonstrable to account for the development of the cystic lesion, it is concluded that penicillamine is the causative factor by means of extensive alteration of the elastic tissue. The morphological changes in the elastic fibres are so characteristic that it is easy to distinguish penicillamine-induced elastosis perforans serpiginosa from the idiopathic variant.