Comparison of post-operative outcomes after open or closed surgical techniques to stabilize metacarpal and metatarsal fractures in dogs and cats.

BACKFROUND: Treatment options for metacarpal/metatarsal fractures include conservative and surgical management. The aim of this study is to determine whether there is any significant difference in healing and complication rates, between open and closed treatment. Medical records of dogs and cats with metacarpal/metatarsal fractures with complete follow-up were retrospectively reviewed. Patients were allocated in two groups: open or closed stabilization. Minor and major complications were recorded and compared. Fracture healing was classified as good, delayed and non-union, and it was statistically compared. RESULTS: Sixty-three patients (35 dogs and 28 cats) were included. Thirty-one were treated with an open approach and 32 by a closed stabilization. Regarding fracture healing a significantly higher proportion of delayed healing/non-union was found in the closed group (12/32 vs 2/31). Regarding postoperative complications, a significantly higher number of animals in the open group did not develop any complications (12/31 vs 3/32). A significantly higher proportion of minor complications were reported in the closed group (27/32 vs 12/31). However, a higher number of major complications was reported in the open group (7/31 vs 2/32) although this was not statistically significant. Fracture malalignment was significantly more prevalent in patients undergoing closed stabilization (11/32 vs 2/31). CONCLUSION: According to the results, better healing, fracture alignment and a lower complication rate are found when fractures are stabilised with an open technique. However, other factors such as configuration of the fracture, soft tissue involvement, patient´s character and client´s situation would also need to be taken into account in the decision of stabilization technique.

Vaginal health, endometrial thickness and changes in bone markers in postmenopausal women after 6 months of treatment with ospemifene in real clinical practice.

OBJECTIVE: To assess vaginal health, endometrial thickness, and changes in bone markers in postmenopausal women with vulvovaginal atrophy (VVA) treated with 60 mg/day of ospemifene under routine clinical practice. METHODS: The AYSEX study is a Spanish observational and prospective study performed in one center in which 5 gynecologists recruited postmenopausal women with VVA in routine clinical practice treated continuously with ospemifene 60 mg/day for 12 months as an appropriate therapeutic option. This article refers to the 3- and 6-months analysis. Vaginal health was assessed by pH and using Vaginal Health Index (VHI) at baseline and 3 months later. Endometrial thickness, measured by vaginal ultrasonography, and bone resorption marker (CTx) were assessed at baseline and 6 months later. RESULTS: A total of 100 postmenopausal women cytologically and clinically diagnosed with VVA were included in the study. After 3 months of treatment with ospemifene, pH improved from 6.1 to 4.5 (p < .0001), and VHI improved from 10 to 19 points (p < .0001). The percentage of patients with VVA according to VHI decreased from 100% to 5.2% (p < .0001). After 6 months, mean CTx levels decreased from 0.42 pg/ml at baseline to 0.37 pg/ml 6 months later (p = .0018), and mean endometrial thickness changed from 2.24 to 2.15 mm (p = .6066). CONCLUSIONS: Up to date, this is the only prospective and observational study with ospemifene in routine clinical practice conditions and confirms the results previously reported from randomized controlled clinical trials, improving VVA, not increasing endometrial thickness, and decreasing CTx levels by exerting an anti-resorptive function.

Multiple session mesotherapy for management of coxofemoral osteoarthritis pain in 10 working dogs: A case series.

The aim of this study was to document the effects of mesotherapy in working dogs diagnosed with hip osteoarthritis (OA) and related pain. Ten police working dogs with hip OA and related pain were treated with a combination of lidocaine, piroxicam, and thiocolchicoside, injected in multiple intradermal points. Seven treatment sessions were conducted. The Canine Brief Pain Inventory (CBPI) and the Hudson Visual Analogue Scale (HVAS) were used in the assessment of response to treatment compared to evaluation before treatment (T0), after 15 d, 30 d, 60 d, 90 d, 120 d, 150 d, and 180 d after initial treatment. Results were compared using the Wilcoxon signed-rank test. Significant differences were experienced in CBPI scores comparing moments with T0: at 15 d (P = 0.03 for Pain Interference Score - PIS) and P = 0.02 for Pain Severity Score - PSS), 30 d (P < 0.05 for PIS and P < 0.05 for PSS), 60 d (P = 0.04 for PIS and P = 0.01 for PSS) and 180 d (P = 0.04 for PSS). Individual treatment results were considered successful in 40% of animals at 15 d and 30 d, 66.7% at 60 d, 44% at 90 d, 37.5% at 120 d, and 25% at 150 d. The HVAS scores showed no significant differences. Mesotherapy may be an option for the treatment of canine musculoskeletal-related pain. Further studies are required.

Mésothérapie en plusieurs séances pour la prise en charge de la douleur arthrosique coxofémorale chez 10 chiens de travail : une série de cas. Le but de cette étude était de documenter les effets de la mésothérapie chez les chiens de travail diagnostiqués avec une arthrose de la hanche (OA) et des douleurs associées. Dix chiens de travail policiers souffrant d'OA et de douleurs associées ont été traités avec une combinaison de lidocaïne, de piroxicam et de thiocolchicoside, injectée en plusieurs points intradermiques. Sept séances de traitement ont été réalisées. Le Canine Brief Pain Inventory (CBPI) et l'échelle visuelle analogique de Hudson (HVAS) ont été utilisés dans l'évaluation de la réponse au traitement par rapport à l'évaluation avant traitement (T0), après 15 j, 30 j, 60 j, 90 j, 120 j, 150 j et 180 j après le traitement initial. Les résultats ont été comparés à l'aide du test des rangs signés de Wilcoxon. Des différences significatives ont été observées dans les scores CBPI comparant les moments avec T0 : à 15 jours (P = 0,03 pour Pain Interference Score ­ PIS) et P = 0,02 pour Pain Severity Score ­ PSS), 30 jours (P < 0,05 pour PIS et P < 0,05 pour PSS), 60 jours (P = 0,04 pour PIS et P = 0,01 pour PSS) et 180 jours (P = 0,04 pour PSS). Les résultats du traitement individuel ont été considérés comme réussis chez 40 % des animaux à 15 jours et 30 jours, 66,7 % à 60 jours, 44 % à 90 jours, 37,5 % à 120 jours et 25 % à 150 jours. Les scores HVAS n'ont montré aucune différence significative. La mésothérapie peut être une option pour le traitement des douleurs musculosquelettiques canines. Des études complémentaires sont nécessaires.(Traduit par Dr Serge Messier).

Ospemifene in clinical practice for vulvo-vaginal atrophy: results at 3 months of follow-up of use.

OBJECTIVE: To assess the effect of ospemifene 60 mg/day in vulvovaginal atrophy (VVA) in postmenopausal women under conditions of routine clinical practice after 3 months of follow-up. METHODS: The AYSEX study is a Spanish observational, prospective, and unicentric study in which 5 gynecologists recruited postmenopausal women with VVA in routine clinical practice treated with ospemifene 60 mg/day as an appropriate therapeutic option. Vaginal health, sexual health, dryness, dyspareunia, quality of life, and satisfaction with treatment were assessed at baseline and after three months using validated scales. RESULTS: A total of 100 postmenopausal women cytologically and clinically diagnosed with VVA were included in the study. After 3 months of treatment with ospemifene, vaginal health index increased and vaginal pH, dryness, and dyspareunia decreased significantly (p < .0001). A significant improvement was observed in sexual function and quality of life. CONCLUSIONS: This study in routine clinical practice conditions confirms the results previously reported by randomized controlled trials, including a significant improvement in VVA, sexual function, quality of life, and satisfaction with the treatment.

A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial.

BACKGROUND: Depression is viewed as a major and increasing public health issue, as it causes high distress in the people experiencing it and considerable financial costs to society. Efforts are being made to reduce this burden by preventing depression. A critical component of this strategy is the ability to assess the individual level and profile of risk for the development of major depression. This paper presents the cost-effectiveness of a personalized intervention based on the risk of developing depression carried out in primary care, compared with usual care. METHODS: Cost-effectiveness analyses are nested within a multicentre, clustered, randomized controlled trial of a personalized intervention to prevent depression. The study was carried out in 70 primary care centres from seven cities in Spain. Two general practitioners (GPs) were randomly sampled from those prepared to participate in each centre (i.e. 140 GPs), and 3326 participants consented and were eligible to participate. The intervention included the GP communicating to the patient his/her individual risk for depression and personal risk factors and the construction by both GPs and patients of a psychosocial programme tailored to prevent depression. In addition, GPs carried out measures to activate and empower the patients, who also received a leaflet about preventing depression. GPs were trained in a 10- to 15-h workshop. Costs were measured from a societal and National Health care perspective. Qualityadjustedlife years were assessed using the EuroQOL five dimensions questionnaire. The time horizon was 18 months. RESULTS: With a willingness-to-pay threshold of €10,000 (£8568) the probability of cost-effectiveness oscillated from 83% (societal perspective) to 89% (health perspective). If the threshold was increased to €30,000 (£25,704), the probability of being considered cost-effective was 94% (societal perspective) and 96%, respectively (health perspective). The sensitivity analysis confirmed these results. CONCLUSIONS: Compared with usual care, an intervention based on personal predictors of risk of depression implemented by GPs is a cost-effective strategy to prevent depression. This type of personalized intervention in primary care should be further developed and evaluated. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01151982. Registered on June 29, 2010.

Intervention to Prevent Major Depression in Primary Care: A Cluster Randomized Trial.

BACKGROUND: Not enough is known about universal prevention of depression in adults. OBJECTIVE: To evaluate the effectiveness of an intervention to prevent major depression. DESIGN: Multicenter, cluster randomized trial with sites randomly assigned to usual care or an intervention. (ClinicalTrials.gov: NCT01151982). SETTING: 10 primary care centers in each of 7 cities in Spain. PARTICIPANTS: Two primary care physicians (PCPs) and 5236 nondepressed adult patients were randomly sampled from each center; 3326 patients consented and were eligible to participate. INTERVENTION: For each patient, PCPs communicated individual risk for depression and personal predictors of risk and developed a psychosocial program tailored to prevent depression. MEASUREMENTS: New cases of major depression, assessed every 6 months for 18 months. RESULTS: At 18 months, 7.39% of patients in the intervention group (95% CI, 5.85% to 8.95%) developed major depression compared with 9.40% in the control (usual care) group (CI, 7.89% to 10.92%) (absolute difference, -2.01 percentage points [CI, -4.18 to 0.16 percentage points]; P = 0.070). Depression incidence was lower in the intervention centers in 5 cities and similar between intervention and control centers in 2 cities. LIMITATION: Potential self-selection bias due to nonconsenting patients. CONCLUSION: Compared with usual care, an intervention based on personal predictors of risk for depression implemented by PCPs provided a modest but nonsignificant reduction in the incidence of major depression. Additional study of this approach may be warranted. PRIMARY FUNDING SOURCE: Institute of Health Carlos III.

Evaluation of different substance combinations in a multiple-session mesotherapy protocol for the management of osteoarthritis in dogs: a retrospective study.

OBJECTIVE: To describe the effect of different substance combinations administered through mesotherapy in dogs with hip osteoarthritis. ANIMALS: 104 dogs. METHODS: In this retrospective study, 4 groups (dogs treated with a combination of lidocaine, piroxicam, and thiocolchicoside [MG]; dogs treated with lidocaine, piroxicam, and Traumeel [TG]; dogs treated with lidocaine, piroxicam, and glucosamine [GG]; and dogs treated with the same combination as in MG combined with a photobiomodulation session [MPG]) were set. For all groups, the same treatment frequency was followed. Response to treatment was measured with the Canine Brief Pain Inventory (divided into pain interference score and pain severity score), Liverpool Osteoarthritis in Dogs (LOAD), and Canine Orthopedic Index (divided into function, gait, stiffness, and quality of life) before treatment and 15, 30, 60, 90, and 120 days after treatment. Cox proportional hazard regression analysis was used to investigate the influence of treatment, age, sex, body weight, breed, and Orthopedic Foundation for Animals score. RESULTS: Dogs had a mean age of 7.6 ± 3.1 years and body weight of 28.6 ± 5.5 kg. Hip osteoarthritis was classified as mild (4), moderate (70), or severe (30). Greater improvements were observed in MG and MPG. Kaplan-Meier estimators showed MG and MPG had longer periods with clinically significant results. Treatment was the covariable that contributed more frequently to the outcomes observed. CLINICAL RELEVANCE: The combination used in MG, particularly combined with photobiomodulation, produced longer-lasting clinically significant results.

Preventing the onset of major depression based on the level and profile of risk of primary care attendees: protocol of a cluster randomised trial (the predictD-CCRT study).

BACKGROUND: The 'predictD algorithm' provides an estimate of the level and profile of risk of the onset of major depression in primary care attendees. This gives us the opportunity to develop interventions to prevent depression in a personalized way. We aim to evaluate the effectiveness, cost-effectiveness and cost-utility of a new intervention, personalized and implemented by family physicians (FPs), to prevent the onset of episodes of major depression. METHODS/DESIGN: This is a multicenter randomized controlled trial (RCT), with cluster assignment by health center and two parallel arms. Two interventions will be applied by FPs, usual care versus the new intervention predictD-CCRT. The latter has four components: a training workshop for FPs; communicating the level and profile of risk of depression; building up a tailored bio-psycho-family-social intervention by FPs to prevent depression; offering a booklet to prevent depression; and activating and empowering patients. We will recruit a systematic random sample of 3286 non-depressed adult patients (1643 in each trial arm), nested in 140 FPs and 70 health centers from 7 Spanish cities. All patients will be evaluated at baseline, 6, 12 and 18 months. The level and profile of risk of depression will be communicated to patients by the FPs in the intervention practices at baseline, 6 and 12 months. Our primary outcome will be the cumulative incidence of major depression (measured by CIDI each 6 months) over 18 months of follow-up. Secondary outcomes will be health-related quality of life (SF-12 and EuroQol), and measurements of cost-effectiveness and cost-utility. The inferences will be made at patient level. We shall undertake an intention-to-treat effectiveness analysis and will handle missing data using multiple imputations. We will perform multi-level logistic regressions and will adjust for the probability of the onset of major depression at 12 months measured at baseline as well as for unbalanced variables if appropriate. The economic evaluation will be approached from two perspectives, societal and health system. DISCUSSION: To our knowledge, this will be the first RCT of universal primary prevention for depression in adults and the first to test a personalized intervention implemented by FPs. We discuss possible biases as well as other limitations. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01151982.

Surgical Treatment of Nonmineralized Supraspinatus Tendinopathy in Dogs: A Retrospective Long-Term Follow-Up.

(1) Background: two forms of supraspinatus tendinopathy (ST) have been reported in dogs: mineralized and non-mineralized. Surgical treatment consists of longitudinal incisions (splitting) in the tendon of insertion of the supraspinatus muscle. The purpose of this retrospective study is to describe the diagnostic workout, the surgical procedure and the short and long term follow up of dogs treated for non-mineralized ST. (2) Methods: medical records (2010-2017) of dogs diagnosed with non-mineralized ST that underwent surgical treatment were reviewed. Data retrieved were: signalment, history, clinical signs, orthopaedic examination findings, diagnostic imaging findings, surgical treatment, histopathologic diagnosis and clinical outcome. (3) Results: A total of 27 dogs met the inclusion criteria. The most consistent clinical findings were intermittent lameness accompanied by pain on palpation of the insertion of the supraspinatus. Magnetic resonance imaging (MRI) of 27 shoulders distended sheaths of the biceps tendon (10/27), compression of the biceps brachii tendon sheaths (5/27) and enlargement of the supraspinatus tendon (3/27) were observed. The most prominent histologic finding was severe myxomatous degeneration in all 27 samples. Resolution of lameness was achieved in 80% of the cases surgically treated without any further lameness episodes in the long-term follow-up. (4) Conclusions: the surgical splitting of the non-mineralized supraspinatus tendon is an effective procedure with no intra-operative complications and a low incidence of minor (18%) and major (4%) complications.

Multiligament stifle injury, a multicenter retrospective study in 26 dogs.

OBJECTIVES: To describe multiligament stifle injury in dogs and report complications and long-term outcomes. METHODS: Medical records of dogs surgically treated for multiligament stifle injury were reviewed from six veterinary hospitals. Long-term follow-up was collected from referring veterinarians. RESULTS: Twenty-six client-owned dogs and 26 stifles were included. Road traffic accidents and limb entrapment were the most common causes of injury. Cranial cruciate and lateral collateral ligament rupture was the most common combination of injury (10 cases). The caudal cruciate ligament was damaged in 12/23 cases but was surgically addressed in only 2 cases. Cranial cruciate ligament rupture was present in all cases and was managed using TPLO (6 cases), extracapsular suture (15 cases) and TTA (2 cases). Postoperative immobilisation with a transarticular external skeletal fixator was used in 4/26 cases. Intraoperative complications were reported in 2/23 cases, short-term complications in 17/25 cases, of which eight were major, and long-term complications in 7/18, of which two were major. Patella luxation was seen in one case and is a previously unreported complication. The overall outcome was excellent in 9/24 cases, good in 5/24 cases, fair in 7/24 cases and poor in 3/24 cases. Follow-up time ranged from 1.5 months to 9 years with the median (IQR) of 9.5 (4.0 to 28.5) months. CONCLUSIONS: Multiligament stifle injury in dogs is associated with a high rate of major complications. The overall outcome was good to excellent in just over half of the dogs.

Clinical Assessment of Introducing Locoregional Anaesthesia Techniques as Part as the Intraoperative Analgesia Management for Canine Ovariohysterectomy in a Veterinary Teaching Hospital.

This study compared four methods to provide intraoperative analgesia during canine ovariohysterectomy in a veterinary teaching hospital. A retrospective study was designed to assess the nociceptive response, cardiorespiratory stability, quality of recovery and complications of four analgesic protocols: epidural analgesia (EPIDURAL group), Quadratus Lumborum block (QLB group), Transversus Abdominis Plane block (TAP group), and just systemic analgesia (GENERAL group). Undergraduate students carried out all the loco-regional techniques under the direct supervision of a qualified anaesthetist. A total of 120 cases met the inclusion criteria and were included in the study and were distributed as follows: 22, 27, 32 and 39 cases with EPIDURAL, GENERAL, QLB and TAP groups, respectively. Data were analysed with statistical software R using different statistical methods. Significant differences among groups were defined as p < 0.05. Based on our results, all the groups needed the same number of rescue analgesia during the intra-operative period. The use of loco-regional techniques anticipated a better quality of recovery compared with the general group. The EPIDURAL group showed a statistically lower expired fraction of sevoflurane. No differences were found regarding complications. In conclusion, these four analgesic methods are suitable and safe to be performed for canine ovariohysterectomy, although loco-regional techniques might have some advantages.

Comparison of surgical and obstetric outcomes in women with uterine leiomyomas after laparoscopic vs. abdominal myomectomy: A single-center cohort study.

Our aim was to study the advantages, complications and obstetrical outcomes of laparoscopic myomectomy (LM) compared with abdominal myomectomy (AM). We conducted a retrospective cohort study at La Paz University Hospital that included LMs and AMs performed between 2012 and 2018, analyzing 254 myomectomies (142 AMs [55.7%] and 112 LMs [43.9%]). The mean number of fibroids was 1.8 ± 1.5 and 3 ± 2.9 for the LM and AM groups, respectively (p < 0.006). The mean size of the largest myoma was 7.6 cm ± 2.7 cm and 10.2 cm ± 5.4 cm for the LM and AM groups, respectively (p < 0.001). LMs were associated with longer surgical times (p < 0.001) and shorter hospitalizations (p = 0.001). There were no significant differences in the intraoperative and postoperative complication rates (p = 0.075 and p = 0.285 for LM and AM, respectively). The subsequent pregnancy rate was higher for the LM group (30.8% vs. 16.8%, p = 0.009), with a vaginal delivery rate of 69% and no cases of uterine rupture.

Traumatic stifle injury in 72 cats: a multicentre retrospective study.

OBJECTIVES: The aim of the study was to describe traumatic stifle injury in cats and report complications and long-term outcome. METHODS: The medical records from seven veterinary hospitals of cats treated for traumatic stifle injury were reviewed. Long-term follow-up data were collected from referring veterinarians and using the Feline Musculoskeletal Pain Index, collected from owners. RESULTS: Seventy-two cats were included in the study. The most common combination of ligament injury involved both cruciate ligaments and the lateral collateral ligament (25.4%). Medial meniscal injury was more common (66.2%) than lateral meniscal injury (59.4%). A temporary transarticular pin was used intraoperatively to aid reduction in 23/73 (31.5%) surgeries. Postoperative immobilisation was applied in 41/72 (56.9%) cats with a mean duration of 4.8 weeks. Short-term complications occurred in 40/64 (62.5%) cats. Long-term complications occurred in seven (17.5%) cats. Overall outcome was excellent in 25/61 (41%) cats, good in 13/61 (21.3%) cats, fair in 11/61 (18%) cats and poor in 12/61 (19.7%) cats. Mean length of follow-up was 29.6 months (range 0.5-204). A significantly poorer outcome was observed in cats with medial meniscal injury and those undergoing revision surgery. Use of a transarticular pin when left in situ for postoperative immobilisation was associated with a poorer outcome (P = 0.043) and a higher risk of complications (P = 0.018). Postoperative immobilisation was not related to outcome. CONCLUSIONS AND RELEVANCE: Traumatic stifle injury in cats can lead to rupture of multiple ligaments causing significant instability of the joint. Surgical treatment is associated with a high rate of short-term complications, although long-term outcome may still be good to excellent in the majority of cats (62.3%). In cats where follow-up was available, postoperative immobilisation had no positive effect on outcome and may not be required. Leaving a transarticular pin for postoperative immobilisation is not recommended as it was significantly associated with a poorer outcome and a higher complication rate.

[Adverse drug reactions of montelukast: from theory to practice. Case report]. / Reacciones adversas a montelukast: de la teoría a la práctica. Serie de casos.

Montelukast is widely used in recurrent wheezing and/or asthma treatment. Several adverse drug reactions (ADRs) have been described in children related to montelukast. Neuropsychiatric reactions are one of the most important. We designed an observational, retrospective, descriptive study on ADRs related to montelukast in the Pediatric Pulmonology Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain. Between January 2012 and December 2017, in the Pediatric Pulmonology Unit, 348 patients were treated with Montelukast; of them, 20 presented RAM. The main symptoms described Reacciones adversas a montelukast: de la teoría a la práctica. Serie de casos Adverse drug reactions of montelukast: from theory to practice. Case report were insomnia (n = 7), hyperactivity (n = 4), nightmares (n = 3), abdominal pain (n = 2) and paraesthesia in extremities (n = 2). They appeared from the first days to months after the start of treatment and disappeared after stopping it. Two patients presented limb paresthesia, not described previously in children. The 5.7 % of our patients treated with montelukast had ADRs that required treatment discontinuation. Sleep disorders were the most frequent.

El montelukast se utiliza ampliamente en el tratamiento de sibilancias recurrentes y/o asma. Están descritas numerosas reacciones adversas medicamentosas (RAM) en niños relacionadas con montelukast; se destacan las neuropsiquiátricas. Realizamos un estudio observacional, retrospectivo, descriptivo, sobre RAM relacionadas con montelukast. Entre enero de 2012 y diciembre de 2017, en la Unidad de Neumonología Pediátrica se trataron con Montelukast 348 pacientes; de ellos, 20 presentaron RAM. Los síntomas más frecuentes fueron insomnio (n = 7), hiperactividad (n = 4), pesadillas (n = 3), dolor abdominal (n = 2) y parestesias en extremidades (n = 2). Se presentaron desde días hasta meses tras iniciar el tratamiento, y desaparecieron tras su suspensión. Se destacan dos pacientes con parestesias en extremidades, síntoma no descrito antes en niños. El 5,7 % de los pacientes tratados con montelukast presentaron RAM que requirieron suspender el tratamiento. Los trastornos del sueño fueron los más frecuentes.

Evaluation of Quadratus Lumborum Block as Part of an Opioid-Free Anaesthesia for Canine Ovariohysterectomy.

Quadratus lumborum block (QLB) is used to provide analgesia for abdominal surgery in humans. The aim of this study was to assess an anaesthetic protocol involving the QLB for canine ovariohysterectomy. Ten dogs were included. Anaesthetic protocol consisted of premedication with IM medetomidine (20 µg kg-1) and SC meloxicam (0.1 mg kg-1), induction with propofol to effect, and maintenance with sevoflurane in oxygen/medical air. QLB was performed injecting 0.4 mL kg-1 of 0.25% bupivacaine/iohexol per side. Computed Tomography (CT) was performed before and after surgery. Fentanyl was administered as rescue analgesia during surgery. The Short Form of The Glasgow Composite Pain Scale and thermal threshold (TT) at the level of the elbow, T10, T13 and L3 were assessed before premedication and every hour postoperatively. Methadone was given as rescue analgesia postoperatively when pain score was >3. A Yuen's test on trimmed means for dependent samples was used to analyse the data (p < 0.05). CT images showed spreading of the contrast/block for a median (range) of 3 (2-5) vertebrae, without differences between preoperative and postoperative images. One dog needed rescue analgesia during surgery. Pain score was less than 4/24 in all the animals during the first 4 h after surgery. TT showed a significant increased signal in all the areas tested, apart from the humerus, 30 min after surgery. The QLB may provide additional analgesia for canine ovariohysterectomy. Further studies are needed to assess the specific contribution of the QLB in abdominal analgesia.

Feline skull injuries: Treatment goals and recommended approaches.

PRACTICAL RELEVANCE: Skull trauma in cats, which includes fractures of the mandible and maxilla, as well as temporomandibular joint (TMJ) conditions, is frequently encountered in general practice. CLINICAL APPROACH: Head trauma requires immediate attention and the initial approach should be focused on stabilisation of the patient and evaluation of the major body systems, including respiratory and cardiovascular assessment, and neurological and ophthalmic examination. The head, oral occlusion and the patient's ability to open and close the mouth should be carefully evaluated. Once the cat is stable enough for anaesthesia, diagnostic imaging is essential to assess for skull injuries. Radiography may be helpful, although some conditions may be difficult to visualise due to soft tissue and bony structure superimposition. CT is a more sensitive technique for detecting skull injuries. TREATMENT GOALS AND TECHNIQUES: A variety of stabilisation techniques have been described in the feline patient, and repair goals focus on restoration of the animal's oral function, while ensuring adequate dental occlusion, minimal invasiveness and morbidity, and pain relief. Surgical repair of mandibular and maxillary fractures may variously involve interdental wiring, interarcade wiring or suture, use of interfragmentary wires, plate and screw fixation, external skeletal fixation and use of dental acrylic. Decision-making with regard to treatment options depends on dental occlusion, type and location of the fracture, fracture stability and pain. AIM: This review, directed at general practitioners working with cats, describes the relevant anatomy of the feline skull, the most common mandibular, maxillary and TMJ conditions, and their recommended management.

A protocol for the determination of the maximal lactate steady state in working dogs.

BACKGROUND: This study aimed to describe a test protocol for the determination of the maximal lactate steady state (MLSS) in dogs. METHODS: Ten animals were submitted to a variable number of sessions (3 to 5), with a duration of 30 minutes each. Every session started with a warm-up period of 10 minutes at 7 km/h, at a 0% inclination. The treadmill was then set at a 5% inclination and at a constant speed, maintained for 20 m. In subsequent sessions, speed was increased or decreased 0.5 km/h. Blood samples were collected, and blood lactate (BL), heart rate (HR), rectal temperature (RT) and glycaemia were determined at rest (T0), after the warm-up (T1) and every 5 minutes until the end of the test (T2-T5). RESULTS: Significant variations were observed in BL, HR and RT, when comparing values at rest and T1 with those at the MLSS level (P<0.01). Mean speed at MLSS was 14.6±1.47 km/h and BL was 2.7±0.45 mmol/L, a value below 4 mmol/L. A correlation between BL at MLSS and the visual lactate threshold was observed (0.87). A strong agreement between blood lactate levels at the MLSS level and LTv was also observed. CONCLUSIONS: The present results consist, to the authors' knowledge, in the first description of a protocol to determine the MLSS in dogs. It provides information for exercise monitoring and training planning.

Osteogenesis imperfecta: Review of 40 patients. / Osteogénesis imperfecta: análisis de 40 pacientes.

INTRODUCTION: Osteogenesis imperfecta (OI) is a heterogeneous genetic disease manifesting as bone fragility and fractures. PATIENTS AND METHODS: Retrospective descriptive study analysing clinical and genetic features, and treatment of patients with OI. RESULTS: Forty patients were included; 32.5% males, 67.5% females; 29 children, 11 adults. Number of fractures at diagnosis with mild OI was 4.6±6.4 (average age at diagnosis 7.8±12.8years), with moderate OI 1.7±2.4 (age at diagnosis .04±.3years), in severe OI 3.7±2.1 and in extremely severe forms 12.5±7.8, both groups diagnosed at birth. Genetic study in 32 patients, 25 with a positive genetic study (pathogenic/probably pathogenic variant). COL1A1 gene was the most frequently affected. In 7 patients, no pathogenic or probably pathogenic variant was found (5 diagnosed by biochemical study of typeI collagen). Nineteen patients were treated with bisphosphonates; 7 combined with growth hormone. The patients treated with bisphosphonates showed clinical improvement (reduction of bone pain and/or irritability) and reduction of fractures. CONCLUSIONS: The COL1A1 gene is the most frequently affected. OI patients should receive multidisciplinary management and bisphosphonates can improve their quality of life.

[Chest deformity as a cause of tracheobronchial compression. A pediatric case]. / Deformidad torácica como causa de compresión traqueobronquial. A propósito de un caso clínico pediátrico.

Idiopathic scoliosis is the abnormal flexion and rotation of the vertebral bodies, causing respiratory symptoms and altered pulmonary function. Straight back syndrome is a decreased in the anteroposterior diameter of the thorax. We present a 13-year-old patient with idiopathic scoliosis who Deformidad torácica como causa de compresión traqueobronquial. A propósito de un caso clínico pediátrico Chest deformity as a cause of tracheobronchial compression. A pediatric case developed progressive dyspnea, inspiratory stridor and a significant decrease in pulmonary function, because of extrinsic compression of the right main bronchus and the middle third of trachea by the thoracic vertebral bodies. She had also a decreased anteroposterior diameter of the thorax, being a determining factor in the appearance of symptoms. Surgery was performed by thoracic vertebra fixation T3 to T11, with subsequent clinical and functional respiratory improvement. Scoliosis associated with altered pulmonary function and stridor should make us suspect the existence of airway compression, especially in patients with reduction of the anteroposterior diameter of the thorax.

La escoliosis idiopática es la flexión y rotación anómala de los cuerpos vertebrales, que puede causar sintomatología respiratoria y alteración de función pulmonar. El síndrome de la espalda recta es una alteración caracterizada por una disminución del diámetro anteroposterior del tórax. Se presenta a una paciente de 13 años afectada de escoliosis idiopática que desarrolló disnea de esfuerzo progresiva, estridor inspiratorio y disminución importante de función pulmonar, secundaria a compresión extrínseca del bronquio principal derecho y tercio medio traqueal por cuerpos vertebrales torácicos. A su vez, tenía una disminución del diámetro anteroposterior del tórax, factor determinante en la aparición de los síntomas. Se intervino mediante fijación de vértebra torácica T3-T11, con posterior mejoría clínica y funcional respiratoria. La escoliosis asociada a alteración de función pulmonar y estridor debe hacer sospechar la existencia de compresión de la vía aérea, especialmente, en pacientes con reducción del diámetro anteroposterior del tórax.

Experimental study of bone lengthening in dogs by means of backscattered scanning electron microscopy.

OBJECTIVE: To describe the morphology of calcified tissues involved in distraction osteogenesis (DO) by means of backscattered scanning electron microscopy (BS-SEM). STUDY DESIGN: Experimental study. ANIMALS: Adult female Beagle dogs (n=12). METHODS: Non-simultaneous and bilateral transverse mid-diaphyseal osteotomies performed in tibiae were stabilized and distracted by a Type Ia external skeletal fixation device. After a latency period of 5 days, distraction was applied at a rate of 0.5 mm every 12 hours for 10 days. Then, the external fixator was maintained in a static mode during the consolidation period until bone healing or euthanasia at 1, 2, 3, 4, 6, 8, 10, 12, 14, and 18 weeks after operations, whichever came first. Distracted regions were isolated and their structure was examined by BS-SEM. RESULTS: Calcified chondroid tissue was prominent during distraction and calcified cartilaginous tissue during consolidation; both tissues were successively replaced by woven, lamellar, and osteonal bone. CONCLUSIONS: In osteotomized tibia, chondroid tissue is the main component of the mineralization front during distraction, calcified cartilaginous tissue during consolidation, and then both tissues are replaced by woven, lamellar, and osteonal bone. The ossification mechanism of distraction callus is transchondroidal. CLINICAL RELEVANCE: BS-SEM is an effective technique for studying progression of bone healing during DO. The presence of chondroid tissue during DO explains why callus mineralization occurs more rapidly during distraction than during static stabilization.