Aberrant right subclavian artery causing megaoesophagus in three cats.

Three entire, domestic, shorthair male cats (age range: 3 months to 5 years) were referred because of regurgitation. Megaoesophagus attributable to aberrant right subclavian artery, originating from the aorta at the level of the fourth intercostal space, was diagnosed in all cats using thoracic radiography and CT angiography. One cat had concurrent patent ductus arteriosus with a normal aortic arch. Three-dimensional volume-rendered CT images were used to assess the malformations and to plan surgery for the treatment of the vascular anomalies. Different surgical approaches were used in the two kittens. The third cat was not operated. CT angiography is well suited for preoperative planning in cats with aberrant right subclavian artery alone or in combination with other vascular anomalies.

A comparison of diaphyseal and metaphyseal techniques of ulna shortening.

The aim of this retrospective study was to compare two techniques of ulna shortening for ulnocarpal abutment. The technique performed initially was diaphyseal osteotomy. Subsequently, a metaphyseal osteotomy was performed to avoid the drawbacks related to the plate. The study group consisted of 29 patients: 13 with diaphyseal and 16 with metaphyseal osteotomies. The pre-operative diagnosis was ulnocarpal abutment in all cases. The results were graded according to the scoring system of Chun and Palmer and patients' self-assessment. Both rankings were related to indications, age, gender, occupation, and surgery. Final follow-up occurred at a median of 54 (range 15-144) months after surgery. There was no delayed union or non-union, necrosis of the ulnar head, or infection. Pain relief was the main benefit. Both techniques gave similar outcomes for pain relief, satisfaction, and objective results. The shortening was significantly greater in the metaphyseal group without any apparent consequence on function or pain. No screw removal was needed after metaphyseal osteotomy; in contrast, plate removal was required in all patients. We conclude that both techniques are valuable alternatives for treating ulnocarpal abutment.

Proximal row carpectomy in emergency.

Proximal row carpectomy (PRC) is a well-accepted procedure for the treatment of early post-traumatic degenerative disease of the wrist. Much less frequently, PRC has been advocated as an emergency procedure for irreparable fracture-dislocation of the wrist. Our objective was to compare the results of PRC in patients having undergone this procedure in the two contexts. We conducted a retrospective analysis of the clinical and radiographic results of six patients treated by emergency PRC as compared to six patients who underwent elective PRC. The mean follow-up was 36 months. Both the patient's satisfaction and the grasp of the wrist joint were significantly better in patients who underwent PRC emergency as compared to those having undergone elective PRC. Quick DASH score, radiographic results, and return to work were also more favourable in these patients, but the difference between the two groups was not significant. This study confirms that PRC is a valuable salvage technique indicated in early posttraumatic wrist collapse. Moreover, when performed in emergency, the procedure shows even better subjective and objective results, allowing a majority of patients to return to their previous job.

A case of Maffucci syndrome.

The Maffucci syndrome consists of a combination of multiple enchondromas and haemangiomas. It appears in the first two decades of life, with no family history. In this case we are reporting about a 26-year-old female who had suffered from multiple enchondromas since the age of two. At the age of nine, the patient presented with additional haemangiomas, which facilitated making proper diagnosis. She now presents with a massive lesion of her left upper extremity. The patient had initially rejected operative treatment when the disease was at early stages. At later stages, a more complex reconstruction of the hand would have been necessary to secure hand function. This procedure that sometimes induces a risk related to potential necessity of blood transfusion was rejected by the patient for religious reasons. Amputation of the extremity was therefore the last resort procedure.

High rate of complications associated with extrafocal kirschner wire pinning for distal radius fractures.

Kirschner wire (K-wire) fixation is a common technique aimed at treating unstable distal radius fractures. We report our experience with extrafocal K-wire fixation in the treatment of unstable distal radius fractures in 34 patients (AO classification: 10 A2, 5 A3, 14 C1, and 5 C2). The patients' median age was 63 years (range, 16-87 years). K-wires remained in place for a median duration period of 42 days, and a splint was applied during 44 days in median. The median follow-up was 2.5 years (range, 1.3-5 years). At the final follow-up examination, all patients were assessed clinically and bilateral radiographs were taken. The median final range of motion was 69 degrees /64 degrees for extension/flexion, 88 degrees/82 degrees for pronation/supination and 36 degrees/21 degrees for ulnar/radial deviation. Grip strength was 81% of the contralateral side. Using the Gartland-Werley score, 12 patients (35%) had excellent results, 17 (50%) good, and five patients (15%) had fair results. The median final radiographic dorsal tilt was 4.5 degrees (range, 0-14 degrees) and 79% of patients had a loss of volar reduction (median 8 degrees). Radial inclination was in median 20 degrees (range, 10-32 degrees) with 82% of the patients with loss of reduction (median 5 degrees). Radial shortening was in median 0.9 mm (range, -2 to +5 mm) and 62% of patients had median loss of radial length of 1.1mm. Radial shortening was the major source of pain due to ulnar impingement. We found a high complication rate, with 15 patients (44%) suffering from at least one of the 30 reported complications. We did not find any direct correlation between radiographic results and mobility. Although good clinical outcome may be obtained, K-wire fixation cannot be routinely recommended.

Primary prostatic haemangiosarcoma causing severe haematuria in a dog.

A 10-year-old, entire, male, mixed-breed dog was presented for severe haematuria and stranguria. Ultrasound revealed a large intraluminal urinary bladder blood clot and a prostatic space-occupying lesion. Invasion of the lesion into the prostatic urethra was detected ultrasonographically during compression of the urinary bladder. Post-mortem examination revealed primary prostatic haemangiosarcoma infiltrating the urethra. Haemangiosarcoma should be considered as a rare cause of prostatic mass lesions, haematuria or lower urinary tract signs in dogs.

[Clinical findings, electroneuromyography and MRI in trauma of the brachial plexus]. / Aspects cliniques, électroneuromyographiques et IRM des traumatismes du plexus brachial.

OBJECTIVES: Management of traumatic lesions of the brachial plexus mainly depends on whether the injury is pre- (nerve root avulsion) or postganglionic (trunks and cords). The aim of this study was to assess the diagnostic and prognostic value of MRI in such lesions, and to determine any correlations among radiological, clinical and electroneuromyographical (EMG) data from both the initial and follow-up studies. MATERIAL AND METHODS: Nine patients with acute traumatic lesions of the brachial plexus were investigated by MRI and EMG. Five further patients served as controls. The MRI protocol included fast spin-echo (FSE) T2-weighted and STIR sequencing. These scans were independently interpreted by two senior radiologists. Their findings were then validated during consensus meetings of surgeons, radiologists and neurologists to identify the exact localization and mechanism of each lesion, and to determine the advantages and drawbacks of each technique. RESULTS: Among the nine patients, MRI scans were judged as normal in three whereas EMG showed distal lesions in two of them. In a further three patients, STIR MRI sequences demonstrated high signal intensities from the trunks and cords of C5 to T1. Among these three patients, MRI at three months showed persistence of these signal anomalies in one patient, and partial regression in the two others. In the remaining three patients, three-dimensional T2-weighted sequences showed nerve root avulsion, consistent with the initial EMG findings. CONCLUSION: MRI is the best technique to demonstrate nerve root avulsion. However, unlike EMG, MRI does not allow visualization of distal lesions of the brachial plexus. Differentiation between edema (reversible) and demyelination (irreversible) of trunk and cord lesions remains difficult, and requires EMG or late MRI.

[The step-cut shortening osteotomy of the shaft of the ulna, technique and results]. / Le raccourcissement du cubitus en baïonnette, indications, techniques et résultats.

Step-cut shortening osteotomy of the ulna for impingment of the distal ulna relies on the principles enunciated by Desanfans 1953. We recommend the plate be placed on either the palmar or the dorsal aspect of the ulna. Used since 1990 this technique has enabled primarily bony healing by 6 months in all the 18 cases operated upon. A significant clinical improvement as measured by the scoring system of Chun and Palmer was noted at a median follow-up of 95.7 months. Shortening did not unfortunately, appear to stabilize the distal ulna and those patients with residual clinical radioulnar instability had significantly worse results. We conclude that the technique presented gives reliable bone healing. It is a versatile and simple technique that requires no special instrumentation but does demand skill and precision.

COX-2 expression in canine and feline invasive mammary carcinomas: correlation with clinicopathological features and prognostic molecular markers.

Cyclooxygenase (COX)-2 is an inducible enzyme linked to tumor growth and angiogenesis. Its expression occurs in a wide range of preneoplastic and neoplastic conditions in humans, including colon and breast carcinomas. We evaluated the role of COX-2 as a mediator of angiogenesis in feline and canine invasive carcinomas (IMCs) and its role as a prognostic indicator. COX-2 expression was assessed in neoplastic samples and healthy mammary glands by immunohistochemistry, and related to the following clinicopathological parameters: age, tumor size, histologic type, tumor grading, vessel invasion, estrogen (ER) and progesterone receptor (PR) status, Ki-67, HER-2 overexpression, microvessel density (MVD), VEGF expression and overall survival (OS). In both species, COX-2 immunoreactivity was not observed in healthy tissues, whereas 96% of feline and 100% of canine invasive carcinomas scored positive. In queens, COX-2 overexpression was significantly correlated to ER-negative status (p=0.04) and to increased PR (p=0.038) expression, and angiogenesis assessed by VEGF expression (p=0.002). In bitches an increased COX-2 expression was significantly correlated to HER-2 overexpression (p=0.013) and to tumor dedifferentiation (p=0.03). In both species increased levels of COX-2 were correlated to poorer prognosis (p=0.03 in dogs and p=0.002 in cats). COX-2 is expressed in mammary tissues during tumorigenesis and its expression is associated with a poorer prognosis in bitches and queens. The correlation of COX-2 expression and angiogenesis provides support for a potential role of COX-2 inhibitors for the prevention and the treatment of feline IMCs via their anti-angiogenic properties. In the canine species, moreover, COX-2 may be important for mediating HER-2 induced mammary tumors.

[Wrist pain]. / Les syndromes douloureux du poignet.

Acute or chronic wrist pain is a relatively frequent complaint that may involve all age groups. The pain may be of osseous, articular, periarticular, neurologic, vascular origin, or be referred from the cervical spine, shoulder or elbow. The diagnosis should be oriented by a precise history and clinical examination. More specialised exams will be required according to clinical findings. Psychosocial and environmental influences need to be taken into consideration.

Diagnosis of occult scaphoid fracture with high-spatial-resolution sonography: a prospective blind study.

BACKGROUND: Evaluation of diagnostic accuracy of high-spatial-resolution sonography (HSR-S) in occult scaphoid fractures. PATIENTS AND METHODS: HSR-S was performed in 24 patients with clinically suspected fracture and normal radiographs. Three levels of clinical suspicion were considered (high, intermediate, and low). Three levels of sonographic suspicion were defined on the basis of cortical interruption, radiocarpal effusion, and scapho-trapezium-trapezoid effusion. Three positive criteria were interpreted as being highly indicative of fracture. Data from sonograms were compared with computed tomography (CT) scans. RESULTS: CT scanning demonstrated a fracture of the scaphoid in five patients. The global sensitivity of HSR-S for detection of occult scaphoid fracture was 100% and the specificity 79%. All patients with demonstrated occult fracture had a high sonography index of suspicion. A high sonography index of suspicion was correlated with 100% sensitivity, specificity, positive predictive value, and negative predictive value. CONCLUSION: HSR-S is a reliable, available, and cost-effective method in early diagnosis of occult fractures of the scaphoid. The presence of three defined criteria is required to assess the diagnosis.

The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb.

We report the results of a new bone-tendon ligamentoplasty for the reconstruction of chronic injuries of the ulnar collateral ligament at the metacarpophalangeal joint of the thumb. The mean follow-up period was 36 months. Using the Glickel grading system, seven patients had excellent results and one patient had good results. The mean loss of pinch strength was 10% compared with the contralateral thumb. The mean loss of motion at the MP joint was 8%. This technique successfully restores the desired long lasting stability while maintaining mobility of the thumb's metacarpophalangeal joint.

Overexpression of HER-2 in feline invasive mammary carcinomas: an immunohistochemical survey and evaluation of its prognostic potential.

The role of c-erbB-2 protooncogene status in feline invasive mammary carcinomas (FMCs) was assessed through the HER-2 receptor immunohistochemical expression. The HER-2 overexpression was then correlated with some relevant histologic parameters and with the clinical course of the disease during a 2-year follow-up. Forty-seven FMCs from surgically treated queens were considered. Tumors were classified according to the WHO criteria and stromal or lymphatic invasion (or both) and histologic grading were recorded. The immunohistochemical staining was performed on paraffin sections and a well-defined scoring system based upon numbers of HER-2 receptors expressed on the cell surface was applied according to standard guidelines. Overall survival (OS) distributions were generated with the Kaplan-Meier method. HER-2 overexpression was detected in 28 of the 47 carcinomas (59.6%). This parameter was demonstrated to be significantly correlated with the shorter OS (P = 0.02). However, the HER-2 overexpression did not show significant correlation with histologic type, tumor grading, or presence of lymphatic invasion. Furthermore, the HER-2 overexpression appeared with a higher percentage in FMCs than what is reported in canine or human mammary carcinomas. The significant correlation with a shorter OS suggests a possible role of HER-2 as an additional marker of malignancy in FMCs and as a reliable prognostic indicator. As in the human oncology practice, the identification of the FMCs that overexpress HER-2 may also promote new therapeutic strategies.

[MRI evaluation of carpal tunnel morphology after carpal tunnel release by a retinaculum lengthening technique]. / Magnetresonanztomographische Beurteilung der Karpaltunnelmorphologie nach Medianusdekompression mittels einer retinakulumverlängernden Technik.

AIM: The benefits of maintaining the pulley function of the flexor retinaculum in carpal tunnel release by lengthening or reconstructing it have been described. Quantitative MR imaging was used to investigate the morphological changes after open carpal tunnel release by such a retinaculum lengthening technique. METHOD: Ten patients had bilateral carpal tunnel MRI pre- and postoperatively. The MRI examinations were performed with a 1.5 Tesla imaging system and wrist coils. Carpal tunnel volume, carpal arch width, median nerve position and flexor tendon position in relation to the hamate-trapezial axis were recorded . RESULTS: Like other methods of carpal tunnel release with complete division of the flexor retinaculum, the retinaculum lengthening technique showed a significant postoperative increase of carpal tunnel volume. Carpal arch width increased only slightly. There was a significant palmar displacement of the median nerve but not of the flexor tendons. CONCLUSION: The findings support the hypothesis that maintenance of the pulley function of the retinaculum may lead to an early postoperative recovery of grip strength. In spite of some difficulties in application quantitative MR imaging may be a useful tool in evaluating the carpal tunnel morphology.

Influence of fracture pattern on consolidation after metacarpal plate fixation.

INTRODUCTION: Consolidation problems may complicate plate fixation of metacarpal fractures. It was our clinical impression that the fracture's morphology and the patient's occupation may influence this complication. METHOD: Retrospective study on 104 extra-articular metacarpal fractures. Time to union, presence of consolidation problems and time to return to work were correlated with fracture pattern (transverse/non-transverse), presence of soft tissue injury, type of patients and type of plate. RESULTS: Twelve patients (15%) experienced consolidations problems: 8 patients within the transverse fracture pattern group (29.6%) and 4 patients (7.4%) within the non-transverse fracture group. The difference was significant (P = 0.01). Manual workers were found to be more likely than non-manual workers to have consolidation problems (p < 0.01) in both groups of fractures. There was no correlation between consolidation problems and hand dominance (P = 0.76), soft tissue injury (P = 0.24) or type of plate (P = 0.34). DISCUSSION: We found a significant correlation between fracture patterns, patients' profession and consolidation problems. Despite technical advances in plate design, management of such fractures by plating remains fraught with complications, demands meticulous handling of soft tissue and does not allow for technical error.

[Unstable fracture of the distal radius and its treatment: comparison of three techniques: external fixation, intramedullary pinning and AO plates]. / La fracture instable du radius distal et son traitement: comparaison de trois méthodes reconnues: fixateur externe, embrochage centromédullaire et plaque AO.

This retrospective study compares 94 distal radius fractures. Sixty one women (median age 66) and 33 men (median age 42) were reviewed clinically and radiologically by a surgeon not involved in treatment. Fractures were classified into three AO groups. Standard X-rays were used for radiological evaluation. Fractures of the distal ulna were evaluated separately. Chi-square tests, Wilcoxon, Mann-Whitney and Fisher's tests were used for statistical evaluation. Women presented mainly "A" type fractures. They were treated by intramedullary pinning. Forty two fractures were grafted, using autogenous bone for young patients and bone substitute for the elderly. Twelve scapholunate dissociations were recorded, all but one were detected in women, 50 years of age or more. Four were painfree, two presented climatic pain and six claimed pain during effort; none had snapping. Radio-ulnar laxity was similar with or without styloid fractures. External fixator and autogenous grafts appeared the most efficient technique for maintaining radial length. Ulnar head fractures were related to a significant higher incidence of sympathetic dystrophy with reduced prono-supination, a correlation not previously noted to your knowledge. This suggests that radius and ulnar head fracture should be classified independently. The amount of pain was not related to classification, internal fixation or gender.

[Is there still a place for conservative treatment of distal radius fractures in the adult?]. / Y a-t-il une place pour le traitement conservateur de la fracture du radius distal chez l'adulte?

Contrary to Colles'opinion which pretended the fracture of the distal radius would heal without sequellae, many studies devoted to this problem showed that complications will affect one third of the cases (malunion, nerve compression, dystrophy, tendon rupture). It is important for the surgeon to know well the different fracture types, the general condition of his patient as well as his osteoarticular state to make the good choice of treatment. Our study shows that the nonoperative treatment will be chosen for any fracture type as far as it concerns an old or crippled patient, especially if there is an osteoporosis. On the contrary, for a young and active patient with a good bone quality, non operative treatment will be chosen as far as the fracture will be reducible and stable. If it is not, an osteosynthesis has to be done. Many studies already published tend to demonstrate that there is a correlation between anatomical and functional results. However, concerning elderly, this correlation tend to disappear with time.

[Utility of bone substitutes: study of 101 distal radius fractures]. / De l'utilité des substituts osseux: à propos de 101 fractures du radius distal.

The aim of the present retrospective study was to evaluate the performance of bone graft substitutes currently in use. After exclusion of those with inadequate data for comparison, 70 out of the 101 operated fractures remained available for statistical analysis. Grafts were used in 38 cases: 23 were bone substitutes and 15 autogenous grafts. Distal radial inclination and lateral angles showed no significant difference. Analysis of ulnar variance showed the relative inability of intramedullary pinning to maintain radial length in the absence of graft. In contrast external fixators preserved radial length both with and without bone grafts, and with all types of graft material. TCH (hydroxyapatite and calcium phosphate) or autogenous bone grafts allowed intramedullary pinning to maintain radial length; whereas collagen matrix material was ineffective. We conclude that TCH and autogenous bone grafts have equivalent effectiveness despite potential bias in this study.