Comparison of injuries between US Army paratroopers and their non-paratrooper soldier counterparts.

INTRODUCTION: Military studies have investigated acute injuries associated with parachute jumps, but the literature does not address paratroopers' cumulative microtraumatic (CMT) injury risk, nor does it compare injury risks between paratroopers and the rest of the military population. This study determined whether US active duty Army paratroopers experienced greater injury risks than their non-paratrooper soldier counterparts and whether their injuries cost more to treat suggesting greater injury severity. METHODS: This retrospective study evaluated electronic medical records (2016-2018) for 31 621 paratroopers and a randomly selected comparison group of 170 715 non-paratrooper soldiers. Analyses included univariate and multivariate regression to quantify odds of injuries associated with risk variables and additional descriptive statistics. RESULTS: Paratroopers had a 57% increase in the odds of experiencing one or more injuries (OR=1.57, 95% CI: 1.52 to 1.62) after controlling for sex, race and age, with a greater proportion of acute injuries (OR=1.38, 95% CI: 1.34 to 1.42), relative to comparison group soldiers. Injury types proportionally higher among paratroopers included head trauma and shoulder injuries. Average injury cost among paratroopers was 13% lower than for non-paratroopers ($2470 vs $2830 per injury). Among both populations, acute injury costs were notably higher than for CMT injuries (paratroopers, $1710/$630; non-paratroopers, $1860/$880 per injury). CONCLUSIONS: Paratroopers were more likely to incur injury, especially an acute injury, than non-paratroopers. However, paratroopers' average injury costs were less. This may be due to higher return-to-duty motivations, fitness levels, and/or facility-specific cost of care. Future studies should investigate causes of injuries found to be proportionally higher among paratroopers.

Pectoralis major injuries in the military: a surveillance approach to reduce an underestimated problem.

INTRODUCTION: Multiple studies report increasing cases of surgically treated pectoralis major (PM) muscle and tendon ruptures in military populations. Studies associate this with a growing popularity of weight-training and bench press exercises. Mild-to-moderate non-surgical PM traumas and overuse injuries have not been included in these studies despite evidence that these types of outpatient injuries account for the majority of the military's injury medical burden. METHODS: To assess rates of all PM injuries (ruptures, tears, strains, overuse), regardless of form of treatment, a PM injury surveillance definition was derived from International Classification of Disease (ICD) diagnostic codes used in routine US Army injury surveillance. A detailed clinical examination of 2016 Active Duty Army medical records was used to identify ICD codes commonly associated with PM injuries. Cost data were calculated and the definition applied to medical data from 2016 through 2018to assess trends. RESULTS: The estimated incidence of PM cases among soldiers was over 95% greater than if only considering severe surgical cases. Over 96% of army annual PM injury costs (direct medical and indirect from lost labour) were for outpatient services. PM injury incidence rates were not statistically different from 2016 to 2018. CONCLUSIONS: The PM injury surveillance definition provides a consistent means to monitor trends over time and evaluate the effectiveness of prevention efforts. PM injuries have a larger military impact than previously recognised and prioritised prevention strategies are needed to reduce them. Future interventions could focus on the bench press given its observed association with PM injuries.

Cor triatriatum dexter in 17 dogs.

OBJECTIVES: The objective of this study was to report the signalment, presentation, clinical and imaging findings, interventions, and outcomes in a group of dogs with cor triatriatum dexter (CTD). ANIMALS: Seventeen client-owned dogs. METHODS: Medical records were reviewed retrospectively for signalment, history, physical examination findings, imaging and diagnostic findings, presence of concurrent congenital cardiac defects, description of interventional procedures, therapy information, and outcomes. RESULTS: Age at presentation ranged from two to 110 months, with 10 of 17 dogs (59%) aged <12 months. There was an equal distribution between the sexes. Peritoneal effusion was the most common presenting complaint, in 10 of 17 dogs (59%). The CTD was an isolated finding in 3 of 17 dogs (18%); the remaining 14 of 17 (82%) dogs had concurrent cardiac disease, with congenital anomalies present in 12 of 17 (70%). All except one of these 12 dogs had at least one additional condition affecting the right heart. Tricuspid valve dysplasia was the most common congenital comorbidity, present in 9 of 17 dogs (53%). Seven dogs (41%) underwent interventional treatment of their CTD. In 7 of 17 (41%) cases, the CTD was considered to be incidental and the dogs were asymptomatic; therefore, no interventions were performed. The remaining three cases were euthanized or lost to follow-up. CONCLUSIONS: Cor triatriatum dexter in dogs is commonly seen in association with other right-sided congenital cardiac anomalies and may be an incidental finding. Dogs with CTD obstructing right atrial inflow can have a good outcome after intervention. Dogs with no clinical signs associated with the CTD may remain asymptomatic into adulthood.

Patient characteristics influencing the variability of distributed parameter-based models in DCE-CT kinetic analysis.

Kinetic parameter variability may be sensitive to kinetic model choice, kinetic model implementation or patient-specific effects. The purpose of this study was to assess their impact on the variability of dynamic contrast-enhanced computed tomography (DCE-CT) kinetic parameters. A total of 11 canine patients with sinonasal tumours received high signal-to-noise ratio, test-double retest DCE-CT scans. The variability for three distributed parameter (DP)-based models was assessed by analysis of variance. Mixed-effects modelling evaluated patient-specific effects. Inter-model variability (CVinter ) was comparable to or lower than intra-model variability (CVintra ) for blood flow (CVinter :[4-28%], CVintra :[28-31%]), fractional vascular volume (CVinter :[3-17%], CVintra :[16-19%]) and permeability-surface area product (CVinter :[5-12%], CVintra :[14-15%]). The kinetic models were significantly (P<0.05) impacted by patient characteristics for patient size, area underneath the curve of the artery and of the tumour. In conclusion, DP-based models demonstrated good agreement with similar differences between models and scans. However, high variability in the kinetic parameters and their sensitivity to patient size may limit certain quantitative applications.

Inhalation chemotherapy for macroscopic primary or metastatic lung tumors: proof of principle using dogs with spontaneously occurring tumors as a model.

This study represents part of an effort to determine the safety and efficacy of inhaled antineoplastic drugs, using pet dogs with spontaneously arising primary and metastatic lung cancers (including sarcoma, carcinoma, and malignant melanoma) as a model. Dogs received new formulations of either paclitaxel (PTX) or doxorubicin (DOX) by the inhalation route every 2 weeks using a specially designed aerosol device. Response was assessed radiographically using the indices of tumor nodule number and volume measurement of discrete pulmonary nodules. Dogs experiencing progressive disease after two consecutive treatments were crossed over to receive the alternate compound. In 24 dogs, 6 (25%) responses were noted including 5 partial responses (PR) and 1 complete response. These include 4 (22.2%) of 18 responses to DOX and 2 (13.3%) of 15 responses to PTX. Responses were noted with osteosarcoma (including three dogs with metastatic osteosarcoma that had failed prior systemic chemotherapy), liposarcoma, hemangiosarcoma, and undifferentiated sarcoma. One dog with mammary carcinoma experienced a 47% reduction in volume after PTX inhalation, just shy of PR criteria. One dog with liposarcoma is experiencing a long-term (>12 months) stabilization of disease on PTX. To date, no systemic toxicities have been observed with either PTX or DOX inhalations. Local (pulmonary) toxicity was not observed with PTX; however, changes consistent with pneumonitis/fibrosis were observed in some dogs receiving DOX. Only one of these dogs showed clinical signs, which were responsive to steroid and antitussive therapy. These data represent "proof of principle" for the avoidance of systemic toxicity while delivering efficacious local drug levels by the inhalation route.

Relationship between quantitative tumor scintigraphy and time to metastasis in dogs with osteosarcoma.

Parameters that predict tumor aggressiveness or response to therapy are potentially useful in selecting the most appropriate treatment. In theory, the biologic aggressiveness of an untreated bone tumor may be reflected in bone scan parameters. The purpose of this study was to assess the usefulness of bone scintigraphy as a predictive indicator of subsequent metastasis in 25 dogs with primary osteosarcoma. Dogs received radiotherapy and/or intra-arterial cisplatin prior to limb-sparing surgery. Quantitative bone scintigraphy of the tumor was performed prior to treatment (25 dogs) and following treatment but prior to limb-sparing surgery (22 dogs). All dogs developed metastasis at a median time of 202 days (range, 41-444 days) after initiation of treatment. A statistically significant relationship was identified between time to metastasis and: (1) the radiographic tumor area, (2) the pretreatment ratio of mean counts per pixel in tumor-to-adjacent nontumor bone (T/NTT), and (3) the pre:post-treatment T/NTT. Larger tumor area and high pretreatment tumor activity were associated with earlier metastasis. Tumors characterized by greater decreases in scintigraphic uptake after treatment were associated with earlier metastasis. These data suggest that osteosarcomas with high pretreatment mean counts per pixel signify aggressive tumors subject to early metastasis.

Postoperative radiotherapy for canine soft tissue sarcoma.

Thirty-five dogs with 37 soft tissue sarcoma tumors that were incompletely excised and treated with radiotherapy in the postoperative, adjuvant setting were reviewed. Variables evaluated included age, sex, tumor site, tumor histology, total tumor radiation dose, radiotherapy field size. time to recurrence, and survival. The majority of tumors were fibrosarcomas and hemangiopericytomas, but small numbers of other tumor types were also represented. Total tumor radiation dose ranged from 42 to 57 Gy given in 3- to 4.2-Gy daily fractions on a Monday through Friday schedule. Overall median survival was 1,851 days. Median time to local recurrence was greater than 798 days. Soft-tissue sarcoma tumors at oral sites had a statistically significant lower median survival (540 days) as compared to other tumor sites (2,270 days). Radiotherapy may be a useful adjuvant therapy for incompletely excised soft-tissue sarcomas with a reasonable expectation for long-term patient survival.

Efficacy and toxicity of paclitaxel (Taxol) for the treatment of canine malignant tumors.

Paclitaxel (Taxol) was administered to 25 dogs with histologically confirmed malignant tumors at a dosage of 165 mg/m2 i.v. over 3-6 hours every 3 weeks. Dogs received premedication with antihistimines and corticosteroids to reduce hypersensitivity reactions. However, 64% of the dogs still experienced allergic reactions. Six dogs (24%) had grade 3 or 4 neutropenia, 6 dogs (24%) required hospitalization and 3 dogs (12%) died of sepsis. Five dogs (20%) had a partial response (osteosarcoma [2 dogs] mammary carcinoma [2 dogs] and malignant histiocytosis [1 dog]) for a median duration of 53 days. The overall toxicity was unacceptable at the 165 mg/m2 dose. Therefore, subsequent evaluations of paclitaxel in tumor-bearing dogs should a starting dose of 132 mg/m2 i.v. every 3 weeks.

Factors associated with return visits to a homeless clinic.

Associations between characteristics of homeless clients and their return visits to a nurse-managed primary health care clinic were examined using a retrospective chart review of 1,467 records from clients seen between 1991 and 1994. Client characteristics examined included age, education, race, gender, sheltered status, report of chronic disease, and report of family living in the area. Only 47 percent of clients made return visits to the clinic. Logistic regression indicated that those with reported chronic disease, males, whites, and those living on the street were more likely to have returned to the clinic for care than those without chronic illness, females, nonwhites, and those living in some type of shelter. Results suggest the need for program planning and evaluation for this population, which particularly considers women, nonwhites, and those without chronic disease as target groups for services.

Rickets caused by excessive renal phosphate loss and apparent abnormal vitamin D metabolism in a cat.

Rickets was diagnosed in a 1-year-old cat with a history of weakness, osteopenia, and recurrent fractures. Processes causing rickets include vitamin D deficiency caused by inadequate, nutrition, lack of exposure to sunlight, defective metabolism of parent vitamin D to active metabolites, inherited vitamin D receptor defects, hypoparathyroidism, chronic renal failure, renal loss of phosphate, or malabsorptive states resulting from gastrointestinal or hepatic diseases. On the basis of analysis of serum 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D2 and D3 concentrations, serum biochemical analysis, and urinary fractional clearance of electrolytes, the causes of rickets in our cat, were most compatible with a combination of excessive loss of phosphorus via the kidneys and deficient or abnormal hepatic 25-hydroxylation of vitamin D. Calcifediol treatment and twice daily administration of phosphate salts resulted in clinical improvement and increases in mineralization of the skeleton, as evidenced on radiographic evaluation.

Clinical and radiographic findings, treatment, and outcome in cattle with osteochondrosis: 29 cases (1986-1996).

OBJECTIVE: To summarize the radiographic and clinical findings, treatment, and outcome in cattle with osteochondrosis diagnosed radiographically. DESIGN: Retrospective case series. SAMPLE POPULATION: 29 cattle with radiographic evidence of osteochondrosis. PROCEDURES: Medical records were reviewed, and owners or referring veterinarians were contacted for outcome assessment. Data were analyzed for potential interactions between osteochondrosis classification (osteochondritis dessicans vs subchondral cyst-like lesions), clinical and radiographic findings, treatment, and outcome, using Fisher's exact test and descriptive statistics. RESULTS: Osteochondrosis was associated with young, male, purebred cattle, clinical evidence of lameness, and radiographic evidence of concurrent degenerative joint disease. Osteochondritis dissecans and subchondral cyst-like lesions had similar clinical findings and outcomes but varied significantly in their radiographic distribution among joints. Osteochondrosis often manifests clinically as a unilateral condition, but bilateral lesions were often found (88%) when limbs were radiographically examined. Cattle managed conservatively tended to be culled (within 6 months of diagnosis because of lameness) more often than those managed surgically, despite the lack of treatment bias. CLINICAL IMPLICATIONS: Osteochondrosis in cattle is often associated with lameness or degenerative joint disease. Conservative management does not result in a favorable clinical prognosis for long-term, lameness-free survival, and more studies need to be completed to evaluate the efficacy of surgical treatment of osteochondrosis in cattle.

Oncologic applications of diagnostic imaging techniques.

Before appropriate therapy can be instituted for a cancer patient, the presence and extent of tumor must be evaluated. Deciding which imaging technique to use depends on tumor location, type, and biologic behavior. Conventional radiography provides important information at a relatively low cost compared with other imaging modalities. Ultrasound is a valuable adjunct to radiography, but does not replace it because both imaging modalities provide unique information. Nuclear medicine procedures contribute additional, unique data by providing physiological information, but specificity is lacking. Both CT and MRI provide images with exquisite anatomic detail, but availability and cost prohibit their general use.

The head: excluding the brain and orbit.

Applications for computed tomography (CT) and magnetic resonance imaging (MRI) scans of the head (excluding the brain and orbit) include the evaluation of neoplastic, inflammatory, and traumatic disorders of the skull (including the cranium, maxilla, mandible, and temporomandibular joints); of the nasal and oral cavities; of the nasopharynx and paranasal sinuses; and of the tympanic bullae. CT and MRI provide information not obtained with routine radiography and should be considered whenever advanced surgical or radiation therapy is anticipated. In this article, the role of CT and MRI in the diagnosis of head disorders will be reviewed and illustrated with case examples.

Image-guided transnasal cryoablation of a recurrent nasal adenocarcinoma in a dog.

An eight-year-old female spayed Airedale terrier with rapid recurrence of a nasal adenocarcinoma following image-guided intensity-modulated radiation therapy was treated with transnasal, image-guided cryotherapy. Ice ball size and location were monitored real-time with computed tomography-fluoroscopy to verify that the entire tumour was enveloped in ice. Serial computed tomography scans demonstrated reduction in and subsequent resolution of the primary tumour volume corresponding visually with the ice ball imaged during the ablation procedure. Re-imaging demonstrated focallysis of the cribriform plate following ablation that spontaneously resolved by 13 months. While mild chronic nasal discharge developed following cryoablation, no other clinical signs of local nasal neoplasia were present. Twenty-one months after nasal tumour cryoablation the dog was euthanased as a result of acute haemoabdomen. Image-guided cryotherapy may warrant further investigation for the management of focal residual or recurrent tumours in dogs, especially in regions where critical structures preclude surgical intervention.

Comparison of computed tomography and magnetic resonance imaging for the evaluation of canine intranasal neoplasia.

OBJECTIVES: Canine intranasal neoplasia is commonly evaluated using computed tomography to indicate the diagnosis, to determine disease extent, to guide histological sampling location and to plan treatment. With the expanding use of magnetic resonance imaging in veterinary medicine, this modality has been recently applied for the same purpose. The aim of this study was to compare the features of canine intranasal neoplasia using computed tomography and magnetic resonance imaging. METHODS: Twenty-one dogs with confirmed intranasal neoplasia underwent both computed tomography and magnetic resonance imaging. The images were reviewed retrospectively for the bony and soft tissue features of intranasal neoplasia. RESULTS: Overall computed tomography and magnetic resonance imaging performed very similarly. However, lysis of bones bordering the nasal cavity and mucosal thickening was found on computed tomography images more often than on magnetic resonance images. Small amounts of fluid in the nasal cavity were more often seen on magnetic resonance images. However, fluid in the frontal sinuses was seen equally well with both modalities. CLINICAL SIGNIFICANCE: We conclude that computed tomography is satisfactory for evaluation of canine intranasal neoplasia, and no clinically relevant benefit is gained using magnetic resonance imaging for intranasal neoplasia without extent into the cranial cavity.

Radiographic patterns of pulmonary metastasis in 25 cats.

Thoracic radiographs of 25 cats with pulmonary metastatic disease and confirmed primary tumors were reviewed retrospectively. Pulmonary patterns of metastasis were divided into three categories, described as well-defined interstitial nodules, ill-defined interstitial nodules or a diffuse pulmonary pattern. The latter consisted of an alveolar pattern with or without ill-defined pulmonary nodules and/or pleural effusion. More cats presented with pulmonary metastatic disease in the category of either ill-defined nodules (n = 10) or a diffuse pattern (n = 7). Within this group, the most commonly represented primary tumor was mammary gland adenocarcinoma.

Asystole associated with iohexol myelography in a dog.

This is a report of a 10-year-old female neutered Doberman Pinscher with a clinical diagnosis of myelopathy. The dog was anesthetized using oxymorphone, thiopental, and halothane in oxygen for a cerebrospinal tap and a myelogram. Iohexal injection into the subarachnoid space by lumbar puncture was uneventful. Additional iohexal was given into the cerebeliomedullary cistern. Immediately following iohexal administration into the cerebellomedullary cistern, several electrocardiographic changes occurred. Two extended periods of asystole responded to intravenous glycopyrrolate administration. A slow multiform ventricular escape rhythm was established after the second dose of glycopyrrolate. Ultimately, atrial activity with apparent AV dissociation resumed, atrial fibrillation developed, and the rhythm converted to normal sinus rhythm. The dog had a normal cardiac examination the following day. Two days later, the dog was anesthetized using a similar anesthetic regimen with maintenance on isoflurane in oxygen for a hemilaminectomy. The dog recovered uneventfully from surgery and was discharged 2 days later.