Giant Red Kidney Worm (Dioctophyma renale) Screening and Treatment Protocol and Aberrant Worm Migration In Dogs From Ontario and Manitoba, Canada.

The life cycle of Dioctophyma renale involves an intermediate host (oligochaete), a paratenic hosts (fish and frogs), and a definitive host (mustelids and canids). Dogs are at risk of infection with D. renale when they consume paratenic hosts infected with the larval form of D. renale. Water containing the oligochaete intermediate host cannot be disregarded as another source of infection. Infections occur mainly in the right kidney, but worms have also been found in the abdominal cavity as well as other organs. Most dogs appear asymptomatic and infections are usually noted as incidental findings on necropsy. Recently, the Ontario Society for the Prevention of Cruelty to Animals (SPCA) and Humane Society conducted transports of dogs located in northern remote communities. In 2016, some female dogs were found to be infected with D. renale upon ovariohysterectomy. In response to this discovery, we developed a screening protocol to screen for D. renale infections. In 2018, a total of 130 intact dogs were transferred from 2 northern communities in the provinces of Ontario and Manitoba. A prevalence of 7.94% (95% confidence interval 3.87-14.11%) was found from dogs from the northern communities. The screening protocol we developed provides a method of screening for dogs that are transported from communities that could be at risk of infection with D. renale.

Higher periprosthetic fracture rate associated with use of modern uncemented stems compared to cemented stems in femoral neck fractures.

INTRODUCTION:: Hemiarthroplasty is the preferred treatment for displaced femoral neck fractures in elderly patients. Recently, short tapered-wedge cementless stems have increasingly been used in this population. However, historic data has consistently shown higher rates of periprosthetic fracture with uncemented stems in hip fracture patients. This study aims to evaluate the rate of periprosthetic fracture requiring re-operation and all-cause mortality between cemented and uncemented femoral stem designs including more recent short tapered-wedge cementless stems in hip fracture patients. METHODS:: A retrospective chart and radiographic review of patients received bipolar hemiarthroplasty for femoral neck fractures from 2010-2016. Patients biologically (age ≥ 65 years) or physiologically (American Society of Anesthesiologists (ASA) class ≥ 3) elderly were eligible. The uncemented group was subdivided into tapered-wedge stems (a broach only system) and reamed uncemented stems. The primary outcome was periprosthetic fracture requiring re-operation. RESULTS:: We included 657 patients in total, with 296 and 361 patients in the uncemented and cemented stem groups respectively. In the uncemented group there were 197 tapered-wedge and 99 reamed uncemented stems. There was a significantly higher rate of periprosthetic fracture requiring re-operation in the uncemented group (3.0% vs. 0.6%) ( p ≤ 0.05). There were no significant differences in rates of all-cause mortality, infection or all-cause re-operation. CONCLUSIONS:: Compared to modern uncemented femoral stem designs, cemented stems yield lower rates of periprosthetic fracture requiring re-operation, without increasing risk of all-cause mortality. Tapered-wedge stems had similar rates of re-operation due to periprosthetic fracture as reamed uncemented stems.