Detection of Neospora caninum DNA in cases of bovine and ovine abortion in the South-West of Scotland.

Neospora caninum is a commonly diagnosed cause of reproductive losses in farmed ruminants worldwide. This study examined 495 and 308 samples (brain, heart and placenta) which were collected from 455 and 119 aborted cattle and sheep fetuses, respectively. DNA was extracted and a nested Neospora ITS1 PCR was performed on all samples. The results showed that for bovine fetuses 79/449 brain [17.6% (14.2-21.4)], 7/25 heart [28.0% (12.1-49.4)] and 5/21 placenta [23.8% (8.2-47.2)] were PCR positive for the presence of Neospora DNA. Overall 82/455 [18.0% (14.6-21.7)] of the bovine fetuses tested positive for the presence of N. caninum DNA in at least one sample. None (0/308) of the ovine fetal samples tested positive for the presence of Neospora DNA in any of the tissues tested. The results show that N. caninum was associated with fetal losses in cattle (distributed across South-West Scotland), compared to sheep in the same geographical areas where no parasite DNA was found. Neospora is well distributed amongst cattle in South-West Scotland and is the potential cause of serious economic losses to the Scottish cattle farming community; however, it does not appear to be a problem amongst the Scottish sheep flocks.

The role of movement errors in modifying spatiotemporal gait asymmetry post stroke: a randomized controlled trial.

OBJECTIVE: Current rehabilitation to improve gait symmetry following stroke is based on one of two competing motor learning strategies: minimizing or augmenting symmetry errors. We sought to determine which of those motor learning strategies best improves overground spatiotemporal gait symmetry. DESIGN: Randomized controlled trial. SETTING: Rehabilitation research lab. SUBJECTS: In all, 47 participants (59 ± 12 years old) with chronic hemiparesis post stroke and spatiotemporal gait asymmetry were randomized to error augmentation, error minimization, or conventional treadmill training (control) groups. INTERVENTIONS: To augment or minimize asymmetry on a step-by-step basis, we developed a responsive, "closed-loop" control system, using a split-belt instrumented treadmill that continuously adjusted the difference in belt speeds to be proportional to the patient's current asymmetry. MAIN MEASURES: Overground spatiotemporal asymmetries and gait speeds were collected prior to and following 18 training sessions. RESULTS: Step length asymmetry reduced after training, but stance time did not. There was no group × time interaction. Gait speed improved after training, but was not affected by type of asymmetry, or group. Of those who trained to modify step length asymmetry, there was a moderately strong linear relationship between the change in step length asymmetry and the change in gait speed. CONCLUSION: Augmenting errors was not superior to minimizing errors or providing only verbal feedback during conventional treadmill walking. Therefore, the use of verbal feedback to target spatiotemporal asymmetry, which was common to all participants, appears to be sufficient to reduce step length asymmetry. Alterations in stance time asymmetry were not elicited in any group.

Encephalitis and neuronal necrosis in a 3-month-old suckled beef calf.

A 3-month-old suckled beef calf from the west coast of Scotland showed neurologic clinical signs for 1 week and was euthanized after failing to respond to treatment. Blood and tissue samples, including the brain, were submitted for diagnosis. Histologic examination of the brain showed neuronal chromatolysis and necrosis in the hind brain and loss of Purkinje cells in the cerebellum, accompanied by mild nonsuppurative encephalitis in the hind brain with a striking lack of inflammation in the cerebellar layers. Other microscopic lesions present were mild nonsuppurative meningitis with perivascular cuffs, diffuse hypergliosis, and occasional foci of neuronophagia. Polymerase chain reaction amplification of viral nucleic acids and specific immunohistochemical labeling allowed the identification of louping ill virus, and serology showed high titers of immunoglobulin M, indicating a recent infection.

Breast conserving surgery for breast cancer involving the nipple.

We present two cases of invasive breast carcinoma with involvement of the dermis and epidermis of the nipple areolar complex (NAC), which were treated with an immediate breast reconstruction. Oncoplastic techniques were utilised in both cases: Latissimus Dorsi Mini Flap in the first and therapeutic reduction mammaplasty in the second. Both methods were used to fill the defect and also to recreate the NAC. We believe these techniques have an expanding role in the repertoire of surgical options for treating breast carcinoma.

Balance impairment limits ability to increase walking speed in individuals with chronic stroke.

Purpose Determine the relationship between balance impairments and the ability to increase walking speed (WS) on demand in individuals with chronic stroke. Methods WS and Berg Balance Scale (BBS) data were collected on 124 individuals with chronic stroke (>6 months). The ability to increase WS on demand (walking speed reserve, WSR) was quantified as the difference between participants' self-selected (SSWS) and maximal (MWS) walking speeds. Correlation, regression and receiver operating characteristic (ROC) analyses were performed to investigate the relationship between balance and the ability to increase WS. Results Of sample, 58.9% were unable to increase WS on demand (WSR < 0.2 m/s). BBS scores were associated with WSR values (rs=0.74, 0.65-0.81) and were predictive of 'able/unable' to increase WS [odds ratio (OR) = 0.75, 0.67-0.84]. The AUC for the ROC curve constructed to assess the accuracy of BBS to discriminate between able/unable to increase WS was 0.85 (0.78-0.92). A BBS cutscore of 47 points was identified [sensitivity: 72.6%, specificity: 90.2%, +likelihood ratio (LR): 7.41, -LR: 0.30]. Conclusions The inability to increase WS on demand is common in individuals with chronic stroke, and balance appears to be a significant contributor to this difficulty. A BBS cutscore of 47 points can identify individuals who may benefit from balance interventions to improve the ability to increase their WS. Implications for Rehabilitation A majority of individuals with chronic stroke may be unable to increase their walking speed beyond their self-selected speed on demand. This may limit functional ambulation, as these individuals are walking "at capacity". Balance impairments contribute to the inability to increase walking speed. A Berg Balance Scale score <47 points can be used to identify individuals with chronic stroke walking "at capacity" due to balance impairments.

Breast carcinoma bone metastasis first presenting to single middle phalanx.

Phalangeal bone metastasis is rare. Breast cancer is known to metastasise to bone but rarely to fingers. This case presents the first site of breast cancer metastasis found on a single proximal phalanx causing pain and affecting hand function. For surgical symptomatic treatment the patient had a ray resection. Post-operatively the patient was pain free with excellent hand function.

Genome sequence of Chlamydophila caviae (Chlamydia psittaci GPIC): examining the role of niche-specific genes in the evolution of the Chlamydiaceae.

The genome of Chlamydophila caviae (formerly Chlamydia psittaci, GPIC isolate) (1 173 390 nt with a plasmid of 7966 nt) was determined, representing the fourth species with a complete genome sequence from the Chlamydiaceae family of obligate intracellular bacterial pathogens. Of 1009 annotated genes, 798 were conserved in all three other completed Chlamydiaceae genomes. The C.caviae genome contains 68 genes that lack orthologs in any other completed chlamydial genomes, including tryptophan and thiamine biosynthesis determinants and a ribose-phosphate pyrophosphokinase, the product of the prsA gene. Notable amongst these was a novel member of the virulence-associated invasin/intimin family (IIF) of Gram-negative bacteria. Intriguingly, two authentic frameshift mutations in the ORF indicate that this gene is not functional. Many of the unique genes are found in the replication termination region (RTR or plasticity zone), an area of frequent symmetrical inversion events around the replication terminus shown to be a hotspot for genome variation in previous genome sequencing studies. In C.caviae, the RTR includes several loci of particular interest including a large toxin gene and evidence of ancestral insertion(s) of a bacteriophage. This toxin gene, not present in Chlamydia pneumoniae, is a member of the YopT effector family of type III-secreted cysteine proteases. One gene cluster (guaBA-add) in the RTR is much more similar to orthologs in Chlamydia muridarum than those in the phylogenetically closest species C.pneumoniae, suggesting the possibility of horizontal transfer of genes between the rodent-associated Chlamydiae. With most genes observed in the other chlamydial genomes represented, C.caviae provides a good model for the Chlamydiaceae and a point of comparison against the human atherosclerosis-associated C.pneumoniae. This crucial addition to the set of completed Chlamydiaceae genome sequences is enabling dissection of the roles played by niche-specific genes in these important bacterial pathogens.

Elevated zinc induces siderophore biosynthesis genes and a zntA-like gene in Pseudomonas fluorescens.

Zinc-regulated genes were analyzed in Pseudomonas fluorescens employing mutagenesis with a reporter gene transposon. Six mutants responded with increased gene expression to elevated concentrations of zinc. Genetic and biochemical analysis revealed that in four of the six mutants the transposon had inserted into genes essential for the biosynthesis of the siderophore pyoverdine. The growth of one of the mutants was severely impaired in the presence of elevated concentrations of cadmium and zinc ions. In this mutant, the transposon had inserted in a gene with high similarity to P-type ATPases involved in zinc and cadmium ion transport. Four mutants reacted with reduced gene expression to elevated concentrations of zinc. One of these mutants was sensitive to zinc, cadmium and copper ions. The genetic region targeted in this mutant did not show similarity to any known gene.

99mTc-DMSA scanning to diagnose pyelonephritic scarring in children.

99mTechnetium-labeled dimercaptosuccinic acid (99mTc-DMSA) scanning provides superior quality images of renal parenchymal detail, which makes it highly sensitive for the diagnosis of pyelonephritic scarring. Unlike most other imaging techniques, radionuclide scanning is not affected by bowel gas or bony structures overlying the kidneys. This makes it particularly useful in children. Furthermore, renal scarring can be demonstrated by 99mTc-DMSA even before the classic gross anatomic and radiologic changes are present. The use of 99mTc-DMSA scanning in over 300 children has demonstrated its benefits and advantages over standard radiographic techniques.

Case report: child abuse--necklace calcification--a sign of strangulation.

Strangulation has been postulated as one cause of cerebral hypoxia in child abuse. This report describes the finding of necklace calcification in an infant with rib fractures and a metaphyseal fracture and an admission of a shaking injury. The calcification is likely to represent fat necrosis as the result of strangulation.

Segmental dilatation of the ileum.

One of the rarer causes of intestinal obstruction in the neonatal period is segmental dilatation of the ileum. The case histories, radiological and histological details of four patients are presented together with a short review of the literature.

Review of spondylolisthesis and spondylolysis in paediatric practice.

Presenting radiographs of 30 children with spondylolisthesis and spondylolysis were reviewed. A 67% incidence of spina bifida occulta was noted, a 13-fold increase of the incidence in the normal population, and a mechanism whereby this may precipitate a spondylolysis is given. The value of the spinous process rotation sign on AP radiographs and facet joint mal-alignment on oblique radiographs in paediatric practice was assessed, and the incidence was 39% and 56% respectively, compared with 92% and 91% in adult practice. Reasons for the reduced incidence are suggested. Oblique radiographs provided further diagnostic information only in the absence of a spondylolisthesis. Follow-up radiographs showed further slip in only five patients. The one constant factor in these five patients was the presence of a spina bifida occulta, indicating the necessity for close observation of such patients with a spondylolisthesis during the adolescent growth spurt. 99Tcm MDP bone scans were performed in three patients, in whom 4 of 5 spondylolyses were shown to have a high uptake. One lesion subsequently became of low uptake as symptoms subsided. Bone scanning in spondylolisthesis needs further evaluation but the finding of increased bone activity suggests a healing process. Spondylolysis is a differential diagnosis to be considered in a positive scan for evaluation of back pain.

Pyogenic sacroiliitis, the missed diagnosis?

Pyogenic sacroiliitis is considered to be an uncommon infection, which is often diagnosed late because of poor localization of symptoms and normal plain radiographs at presentation. Nine cases aged between 20 months and 14 years who presented with sacroiliitis over a 7 year period are reviewed retrospectively. Isotope bone scanning is a useful technique in establishing early diagnosis and its relationship to other diagnostic imaging modalities is discussed. By routinely obtaining views of the entire pelvis in children presenting with hip pain and a limp, pyogenic sacroiliitis may be detected more frequently.

Infantile myofibromatosis--a review.

Infantile myofibromatosis is a rare condition which usually presents in childhood. It has a wide spectrum of disease activity, ranging from a solitary cutaneous nodule, through to a multicentric form with widespread visceral involvement. We present four cases which demonstrate the diversity of this condition and its radiological findings, together with a review of the literature.

Case report: complete photopenia of the femoral head on radionuclide bone scanning in septic arthritis of the hip.

Three cases of septic arthritis of the hip are presented. In each case, radionuclide bone scanning, using 99Tcm diphosphonate (MDP), demonstrated complete photopenia of the femoral head. All three cases resulted in avascular necrosis and subsequently had a poor clinical outcome with a reduced range of movement and radiographic epiphyseal deformity. Complete photopenia in the presence of suspected sepsis requires urgent referral with a view to exploration and decompression.

The radiological evaluation of multiple pin fixation of the femoral head.

Following pin fixation of the femoral neck, extrusion of a pin tip into the joint space cannot be excluded with conventional bi-plane radiography. A per-cervical pin was allowed to extrude from the head of a dried femur. Anteroposterior and lateral photographs and roentgenograms of this preparation, simulating corresponding intra-operative radiology, demonstrated misleadingly that the pin tip was wholly within the head. Careful intra-operative and post-operative screening is considered important to detect unwanted joint penetration and so avoid avascular necrosis and late degenerative change.

Radiation exposure to children during cardiac catheterization.

The purpose of this study was to assess the suitability of different radiation dosimetry methods and record radiation exposures during paediatric catheterization. Three methods of dosimetry were employed: thermoluminescent dosimetry (TLD), dose-area product and calculation of entrance surface dose from calibrated exposure factors. Examinations included bi-plane fluoroscopy, and cineangiography for diagnosis and treatment of congenital heart disease. The most suitable method of radiation dosimetry for cardiac catheterization is the use of calculated entrance dose or a dose-area product meter. Children were exposed to high levels of radiation during cardiac catheterization but there was a wide variation in radiation dosage. Careful consideration should be given to the suitability of radiation dosimetry for cardiac catheterization.

Endometroid adenocarcinoma of the cervix in a 9-year-old girl.

We present the first reported case of endometroid adenocarcinoma of the uterine cervix in a young girl. The differential diagnosis of a vaginal mass in this age group is usually rhabdomyosarcoma, although other, rarer tumours also occur.

Digital radiography in paediatrics: radiation dose considerations and magnitude of possible dose reduction.

The purpose of this study was to evaluate the radiation doses received by paediatric patients examined using a digital radiography unit, and to compare these doses with those received from conventional screen-film systems. In this way, guidelines could be drawn up concerning the magnitude of possible dose reductions achievable using digital radiography. The study was undertaken on approximately 900 patients undergoing abdomen, chest, pelvis and skull examinations. Patients were categorized into the following age groups: 0-1 month, 1-12 months, 1-5 years, 5-10 years and 10-15 years. Approximately half were X-rayed using a Fuji computed radiography system and half using a conventional screen-film system. Entrance surface dose was calculated from the recorded exposure parameters and measured X-ray tube outputs. Dose-area product was recorded directly. Image quality was assessed clinically using criteria recommended by a working group of the Commission of the European Communities. Apart from chest examinations, it was found possible to reduce doses by about 40% on average, by using a computed radiography system instead of a 600 speed screen-film combination. There was no significant difference in the dose for chest examinations. Satisfactory image quality can therefore be achieved by using computed radiography as a 1000 speed system for abdomen, pelvis and skull examinations, and as a 600 speed system for chests. Since very few departments appear to use screen-film systems of speeds greater than 400, then, for most departments, the use of computed radiography would result in dose reductions of at least 60%, or 33% for chests.

Iodixanol in paediatric gastrointestinal imaging: safety and efficacy comparison with iohexol.

Iodixanol (Visipaque) is a dimeric, non-ionic iodinated contrast medium that is isotonic with blood at all clinically relevant concentrations. Iodixanol was compared in a randomized, double blind, parallel group, phase III multicentre trial with a monomeric, non-ionic contrast medium, iohexol (Omnipaque), at two concentrations assessing safety, tolerability and radiographic efficacy during contrast enhanced gastrointestinal radiography examinations of children. 154 children entered the trial; 152 formed the safety population and 147 the efficacy population. All examinations were performed following standard departmental practice. Children were assigned into either a high or low concentration group (iodixanol, 150 mgI ml(-1) and 320 mgI ml(-1) vs iohexol, 140 mgI ml(-1) and 300 mgI ml(-1)). The primary outcome measure for efficacy was the overall quality of visualization, which was assessed using a 100 mm visual analogue scale (VAS). The secondary efficacy variables assessed were quality of contrast opacification, mucosal coating and overall quality of diagnostic information. Safety evaluation involved patient follow-up for at least 48 h. Taste acceptance was also assessed. There was no statistically significant difference between the two contrast media with regard to the primary and secondary efficacy variables assessed, although higher ratings were observed for iodixanol. The 100 mm VAS score overall was 86 mm for iodixanol and 82 mm for iohexol (95% confidence interval -2.56, 10.42). The frequency of adverse events was lower for patients receiving iodixanol. Adverse events, mainly diarrhoea, occurred in 12 patients (16.2%) in the iodixanol group and 28 patients (35.9%) in the iohexol group. This reached statistical significance (p=0.006). Overall, iodixanol is well suited for examinations of the gastrointestinal tract, giving good efficacy results and fewer adverse events than iohexol.