Carpal canal lipoma causing lameness in a dog.

Carpal canal syndrome, or carpal tunnel syndrome, is the most common entrapment neuropathy in humans and is caused by compression of the median nerve as it courses through the carpal canal. A similar condition has been reported in horses, however there have not been any reported cases of a dog showing lameness secondary to compression within the carpal canal. This report describes the case of a dog exhibiting lameness secondary to a lipoma within the carpal canal. Lameness improved after surgical removal of the mass. This case highlights the need to consider compression of the tendons and nerves in the carpal canal as a cause of forelimb lameness in dogs when pain is localised to the carpus.

Delayed spinal cord injury following microchip placement in a dog.

A three-year-old female, entire Yorkshire Terrier dog was examined because it had progressive non-weight-bearing left forelimb lameness and tetraparesis of two weeks duration. Clinical signs were first observed following mating. Examination confirmed non-weight-bearing left forelimb lameness and tetraparesis. Left forelimb muscle atrophy was also noticed. Survey radiography revealed a metallic foreign body consistent with a microchip in close proximity to the left articular facets between the fifth and sixth cervical vertebrae. Computed tomography identified the exact location of the foreign body encroaching on the left dorsolateral vertebral canal, and osteolysis of the lamina of the sixth cervical vertebra. Surgical removal of the foreign body was performed via a dorsal approach to the caudal cervical vertebral column. Two weeks following surgery the dog showed return of left forelimb function and resolving tetraparesis. Microchip implantation had been performed three years previously.

Long-term outcome of jejuno-ileal bypass surgery for superobesity: a psychiatric assessment.

In this study of the long-term psychosocial consequences of jejuno-ileal bypass, 24 patients were assessed with psychiatric interviews and psychological tests 4-12 years after the procedure. Twenty patients had had a good overall response to the surgery, and 4 had had a poor response. Most complications, physical and psychiatric, occurred during the first 3 years. Most patients with a good postoperative result maintained it for many years, gained occupationally and vocationally, were pleased with the results of the operation, and were willing to recommend it to others. Even those who had experienced complications tended to underrate their seriousness and to express satisfaction.

Effect of mutations of murine lens alphaB crystallin on transfected neural cell viability and cellular translocation in response to stress.

We examined the influence of over-expressed native and mutant murine lens alphaB crystallin on the response of a murine neural cell line to heat and ionic strength shock. Native and mutant (F27R and KK174/175LL) murine alphaB crystallin amplicons were subcloned into a Lac-Switch IPTG-inducible RSV promoter eukaryotic vector, and transfected into N1E-115 cells using lipofectin. Expression was induced maximally 8 h after addition of IPTG (optimal final concentration 1 mM) to the medium. Cells grew normally after transfection with native and mutant murine alphaB crystallin. We demonstrated expression of the protein using specific anti-alpha crystallin antibodies. Viability under severe heat and ionic strength stress increased when cells had been transfected with native alphaB crystallin, but not with mutants F27R or KK174/175LL. Heat shock caused translocation of both native and mutant alphaB crystallins into the central region of the cells. These results show that mutations in alphaB crystallin that effect its chaperone-like activity may also influence viability of N1E-115 neural cells under stress, while not influencing the distribution of the protein within the cell.

Morbid obesity: problems associated with operative management.

A review of the problems associated with extensive jejunoileal bypass for morbid obesity in a series of 175 carefully selected patients is presented. Five postoperative deaths occurred (3%). Nonfatal complications occurred in 21%, with wound infections (14 patients) being the most common. Good results marked by weight reduction to the range of ideal weight without significant electrolyte or metabolic aberrations was observed in 82% of the patients receiving the current dimensional modificatiom of end-to-end jejunoileal bypass (30 cm to 20cm). An additional 13% had fair results and only 5% had poor results. There were six deaths during follow-up: liver failure in four patients (secondary to alcohol abuse in two), myocardial infarction in one, and one from unknown causes. Bypass reversal was necessary for refractory liver failure in three patients (two from alcohol abuse), and for persistent diarrhea with secondary electrolyte depletion in two patients. One of these patients was complicated by severe emotional instability. This experience suggests that the majority of carefully selected patients will have a good response to jejunoileal bypass.

Maintenance of chaperone-like activity despite mutations in a conserved region of murine lens alphaB crystallin.

PURPOSE: To understand the relationship between certain conserved residues in alphaB crystallin and the chaperone-like function of the protein. METHODS: In alphaB crystallin, residues H101 to R120 are highly conserved between alphaB crystallin and alphaA crystallin (85% identity), and between alphaB crystallin and the small heat shock protein hsp 27 (80% identity). We made three substitution mutants of alphaB crystallin: the single mutant F118A, and the double mutants K103L/H104I, and E110H/H111E. RESULTS: Polyacrylamide gel electrophoresis revealed no decrease in aggregate size or measureable structural changes between them and the native structure. Using the insulin aggregation assay, all three mutants had identical chaperone-like activity to the wild-type recombinant alphaB crystallin. CONCLUSIONS: Despite the high conservation in this area of sequence between alphaB crystallin, alphaA crystallin, and the small heat shock protein hsp 27, mutations F118A, K103L/H104I, and E110H/H111E did not significantly alter chaperone-like activity.

Small heat shock proteins (sHSPs) as potential drug targets.

Small heat shock proteins (sHSPs) belong to a family of 12- to 43-kDa proteins that are ubiquitous and are largely conserved in amino acid sequence among all organisms. The principal heat-shock proteins that have chaperone activity (that is, they protect newly made proteins from misfolding) belong to five conserved classes: HSP100, HSP90, HSP70, HSP60 and the small heat-shock proteins (sHSPs). The sHSPs (which include alpha crystallin) can form large multimeric structures and have a wide range of cellular functions, including endowing cells with thermotolerance in vivo and being able to act as molecular chaperones in vitro; sHSPs do this by forming stable complexes with folding -or unfolding--intermediates of their protein substrates, probably the molten globule. This paper includes: a brief survey of the chaperone family, the small heat shock protein superfamily, transcription of sHSPs, sequence comparisons and structural models of small heat shock proteins--structural elements as potential drug targets, sHSPs as chaperone-like proteins, alpha crystallin chaperone-like activity, conformational diseases--the role of alpha crystallin small heat shock protein superfamily proteins, post-translational modification and useful pharmacological agents. Functionality of small heat shock proteins--targets and diseases where pharmacologically active agents are of importance, alpha crystallin--small heat shock proteins and prion diseases: specific targets for diagnostic tests and drug development, details of some specific small heat shock proteins as drug targets, structural and functional implications for treatment.

Carcinosarcoma of ileum in regional enteritis.

A biphasic malignant neoplasm, carcinosarcoma, arose in a segment of ileum involved with regional enteritis. The tumor spread throughout the abdomen, and the patient died nine months after diagnosis. The spectrum of intraepithelial dysplasia, carcinoma with varying degrees of differentiation, and sarcomatous-appearing elements suggests that the histogenesis of this tumor is epithelial. This report provides further documentation of the relationship between regional enteritis and unusual neoplasms of the intestine.

Oncologic aspects of pheochromocytoma: the importance of follow-up.

During a 33-year period at Vanderbilt University Medical Center and its long-standing affiliated hospitals, Veterans Administration Medical Center and Metropolitan Nashville General Hospital, 69 patients with pheochromocytoma were seen. Despite the fact that hypertension was present in all patients at initial admission, in 11 patients seen during the 1950s the clinical diagnosis of pheochromocytoma was not made and the existence of this tumor was discovered at autopsy examination. In 58 patients the clinical diagnosis of pheochromocytoma was made and surgical excision of pheochromocytoma (or biopsy only in two cases) was carried out. One patient died during the initial postoperative period (1.7%). All of the operative survivors were followed to date or the death, with the exception of three who were lost to follow-up at 18 months and 7 and 11 years, respectively. The incidence of malignant disease in this carefully followed group of patients with pheochromocytoma was impressive. Nine of 69 patients (13%) proved to have malignant pheochromoblastoma, all but one of whom have died. Additional malignant tumors have occurred in two of these nine patients (22%) with proved malignant pheochromoblastoma and in 14 of 60 patients (23%) with benign pheochromocytoma. The overall incidence of additional malignant tumors in the collective group of patients with the histopathologically confirmed diagnosis of pheochromocytoma was thus 23% (16/69 patients). It is also interesting that a variety of benign neoplasms occurred in the 60 patients with benign pheochromocytomas (9/60; 15%). If the nine patients with malignant pheochromoblastoma are added, the overall incidence of malignant disease in these 69 patients with pheochromocytoma is 25/69 or 36%. Follow-up of patients with pheochromocytoma is mandatory on a lifetime basis and preferably by the operating surgeon.

Results of an aggressive surgical approach to gastric carcinoma during a twenty-three-year period.

The early work of Dr. William Longmire with total gastrectomy for gastric carcinoma prompted us to initiate an aggressive surgical approach to gastric carcinoma in 1960: in curative resections radical total gastrectomy with hepaticoceliac-left gastric arterial node dissection was to be performed for tumors involving the entire stomach or upper two thirds and radical 80% to 90% subtotal gastrectomy with similar node dissection for tumors located in the antrum. During a 23-year period 213 patients with confirmed gastric carcinoma were studied. Celiotomy was performed in 192: advanced gastric cancer was found in 185 and seven had early gastric cancer. In only 80 patients could resections for "cure" be done. In 31 patients who underwent total or extended total gastrectomy the operative mortality rate was 9.6%, and life table survival curves show a better survival rate than in 49 patients treated by subtotal gastrectomy, with an operative mortality rate of 16.3%. The study shows the urgent need for diagnosis of early gastric cancer by gastroscopic screening of adults at risk and the meager salvage by radical resection in advanced disease.

Surgical experience with retrogastric and retropancreatic pheochromocytomas.

From 1972 to 1981 at Vanderbilt University Hospital there were seven patients with midline retrogastric or retropancreatic pheochromocytomas. Each of these tumors arose between the aorta and the inferior vena cava. This report details the difficulties in localization before and at operation in the smaller tumors in these sites. Our experience suggests that small midline pheochromocytomas in these sites may be readily missed by computerized tomographic scan, aortography, or surgical search at laparotomy unless subtraction arteriograms are used and the Kocher maneuver is employed at operation routinely.

Surgical treatment of popliteal artery injuries.

Twenty-seven patients with injury to the popliteal artery and associated structures were operated on during the past 15 years. There was no operative or hospital deaths. The limb salvage rate was 56%; the amputation rate was 44%. Those patients with penetrating injuries were found to have a much better salvage rate (85%) than those with blunt trauma (29%). Preoperative arteriography and immediate repair of the popliteal artery by either end-to-end anastomosis or a vein graft is advocated for these patients. Popliteal vein injuries should be repaired when possible by lateral suture or end-to-end anastomosis. Fasciotomy is advocated on a selected basis.

Alterations in plasma lipid concentrations in normal and hyperlipidemic patients with morbid obesity before and after jejunoileal bypass.

In a study of 193 massively obese patients plasma lipoprotein concentrations were elevated in 94 patients and were within normal limits in 99 patients. Jejunoileal bypass, in addition to causing weight loss, lowered plasma lipids in both groups to normal or below normal levels.

Surgical experience with jejunoileal bypass for morbid obesity.

Jejunoileal bypass for morbid obesity with our current bowel length dimensional considerations has achieved good results in 74 per cent of patients. Morbidity and mortality are significant and must limit wide application of the procedure.

Experience with adrenocortical neoplasms in childhood.

The experience with adrenocortical neoplasms in childhood is reviewed. During three decades, ten children with adrenocortical neoplasms were seen at the authors' institution. The literature was reviewed, and 209 patients 16.5 years or younger were found. All ten patients at Vanderbilt University Hospital (VUH) presented with endocrine manifestations of the tumor. Three patients had Cushing's, two patients had virilization, and five patients had features of both. In the literature, virilization, alone or with Cushing's, was the most common mode of presentation. Feminizing tumors were uncommon and nonfunctional tumors rare. The majority of patients were female. Features associated with malignancy included 17-KS levels greater than 40 mg/24 hr, diameter greater than 6 cm, weight greater than 500 g, and histologic evidence of diffuse growth pattern, vascular invasion, and tumor cell necrosis. Although uncommon, adrenocortical neoplasms should be suspected in children with Cushing's, virilization, feminization, or a combination of these. There has been an increased incidence reported in patients with hemihypertrophy, Beckwith-Wiedemann syndrome, hemangiomas, and nevi. Following endocrinologic evaluation, imaging studies should be performed. CT scan appears to be the most useful diagnostic tool. A posterior operative approach is recommended for suspected adenomas. An anterior thoracoabdominal approach is favored for suspected malignancies with uncompromised en bloc resection. There is no evidence that adjuvant therapy provides any additional benefit.

Pseudotumor of the lung.

Benign lung tumors in children are rare. An equally uncommon finding is the inflammatory pseudotumor, a lesion that is grossly similar to a tumor and yet cannot be histologically defined as a neoplasm. They have been called xanthomas, histiocytomas, solitary mast cell granulomas, and xanthogranulomas by various authors. There is a tendency to overtreat these lesions as if they were malignant. In previous reports, lobectomy has been the usual treatment for these tumors. If a pseudotumor is suspected at exploratory thoracotomy, a wedge resection and frozen section should be considered. When these benign lesions are easily accessible, they can be enucleated, leaving all of the normal pulmonary tissue intact without compromising cure.

Surgical experience with hyperparathyroidism.

This is a retrospective analytic review of 208 patients with hyperparathyroidism studied and treated at Vanderbilt University Hospital from 1935 to 1980. Follow-up in these patients has been completed to date or to death in a great majority of patients. Results indicate the value of excision of isolated adenomas and of subtotal parathyroidectomy for primary and secondary hyperplasia.

Hemilaminectomy for the treatment of thoracolumbar disc disease in the dog: a follow-up study of 40 cases.

A study was made of dogs with Hansen type I thoracolumbar disc extrusions that had been treated by hemilaminectomy and fenestration of the affected disc. Follow-up information was available for 40 dogs undergoing treatment over a five-year period. The follow-up period ranged from 12 to 72 months (mean 34 months). The case details and the results of treatment of these 40 dogs are presented. All dogs were graded according to the degree of neurological dysfunction at the time of initial presentation and at the conclusion of the study period. Twenty-seven dogs (68 per cent) had no detectable signs of neurological dysfunction or thoracolumbar pain at the final assessment and a further eight dogs (20 per cent) had mild ambulatory paraparesis but were regarded by their owners as functional pets. Recurrence of neurological signs consistent with thoracolumbar disc disease was seen in five dogs (13 per cent) and was successfully resolved completely in one of three dogs that were treated.

Laminectomy for 34 dogs with thoracolumbar intervertebral disc disease and loss of deep pain perception.

The case details and the results of treatment of 34 dogs with thoracolumbar intervertebral disc disease, without deep pain perception, that had been treated by laminectomy and fenestration, are presented. The association of a number of potential prognostic factors with the neurological outcome is examined. Twenty-one dogs (62 per cent) recovered neurological function, seven (21 per cent) failed to recover neurological function and three (9 per cent) developed progressive myelomalacia postoperatively, while three dogs (9 per cent) were euthanized intraoperatively because of diffuse myelomalacia. Twenty of the dogs that recovered neurological function showed a return of deep pain perception within two weeks of decompressive surgery. Statistical analysis showed significant differences in the outcome between dogs that took less than one hour to lose the ability to ambulate and dogs with a longer duration of onset of inability to ambulate. The extent of spinal cord swelling determined by myelography was not found to be a useful prognostic indicator.

Fibro-cartilaginous embolism in a cat.

A nine-year-old cat was presented with a history of an acute onset of paraplegia. On the basis of the neurological examination, the lesion was localised between the fourth lumbar and third sacral segments (L4 to S3) of the spinal cord. Investigations included radiography, myelography, cerebrospinal fluid analysis, routine haematology and biochemistry, feline leukaemia virus testing and urinalysis. A definitive diagnosis was not achieved and the cat was euthanased 12 days after presentation. Post mortem examination revealed infarction of the spinal cord secondary to fibrocartilaginous embolisation. This is the first reported case of fibrocartilaginous embolism in the cat in the UK.