The effect of mental fatigue on the performance of Australian football specific skills amongst amateur athletes.

OBJECTIVES: This study investigated the effects of induced mental fatigue on the performance of Australian football (AF) specific skills amongst amateur AF players. DESIGN: Randomised cross over trial. METHODS: Twenty-five amateur AF players performed a series of standardised tests from the Australian Football League (AFL) Draft Combine after completing a 30-min Stroop test (mental fatigue condition) or 30-min control condition. The AFL Draft Combine tests included the standing vertical jump test, running vertical jump test, agility test, 20m sprint, Matthew Lloyd clean hands test, Brad Johnson goal kicking test and a Yo-Yo Intermittent Recovery Level 1 (Yo-Yo IR1) test. RESULTS: The Stroop test score decreased during the Stroop test (first five trials: mean=84.7, SD=3.5; last five trials: mean=82.2, SD=5.0, p=0.03). The Yo-Yo IR1 test (mental fatigue: median=920m, IQR=400; control: median=1040m, IQR=760; p=0.03) and Brad Johnson goalkicking test (mental fatigue: median=19.0, IQR=5.0; control: median=25.0, IQR=10.0, p=0.048) were negatively affected by mental fatigue. No other Draft Combine tests demonstrated a negative affect from mental fatigue. CONCLUSIONS: Mental fatigue had a detrimental influence on the performance of AF specific skills. The findings may have implications for AF players who are required to sustain attention and concentration for prolonged periods before and during matches.

Impact of postoperative complications on disease recurrence and long-term survival following oesophagogastric cancer resection.

BACKGROUND: Postoperative complications after resection of oesophagogastric carcinoma can result in considerable early morbidity and mortality. However, the long-term effects on survival are less clear. METHODS: All patients undergoing intentionally curative resection for oesophageal or gastric cancer between 2006 and 2016 were selected from an institutional database. Patients were categorized by complication severity according to the Clavien-Dindo classification (grades 0-V). Complications were defined according to an international consensus statement. The effect of leak and severe non-leak-related complications on overall survival, recurrence and disease-free survival was assessed using Kaplan-Meier analyses to evaluate differences between groups. All factors significantly associated with survival in univariable analysis were entered into a Cox multivariable regression model with stepwise elimination. RESULTS: Some 1100 patients were included, with a median age of 69 (range 28-92) years; 48·1 per cent had stage III disease and cancer recurred in 428 patients (38·9 per cent). Complications of grade III or higher occurred in 244 patients (22·2 per cent). The most common complications were pulmonary (29·9 per cent), with a 13·0 per cent incidence of pneumonia. Rates of atrial dysrhythmia and anastomotic leak were 10·0 and 9·6 per cent respectively. Patients with a grade III-IV leak did not have significantly reduced overall survival compared with those who had grade 0-I complications. However, patients with grade III-IV non-leak-related complications had reduced median overall survival (19·7 versus 42·7 months; P < 0·001) and disease-free survival (18·4 versus 36·4 months; P < 0·001). Cox regression analysis identified age, tumour stage, resection margin and grade III-IV non-leak-related complications as independent predictors of poor overall and disease-free survival. CONCLUSION: Beyond the acute postoperative period, anastomotic leak does not adversely affect survival, however, other severe postoperative complications do reduce long-term overall and disease-free survival.

Cortical motor threshold determination in dogs.

In humans, determining the cortical motor threshold (CMT) is a critical step in successfully applying a transcranial magnetic stimulation (TMS) treatment. Stimulus intensity, safety and efficacy of a TMS treatment are dependent of the correct assessment of the CMT. Given that TMS in dogs could serve as a natural animal model, an accurate and reliable technique for the measurement of the CMT should be available for dogs. Using a visual descending staircase paradigm (Rossini paradigm), the CMT repeatability was assessed and compared to the electromyographic (EMG) variant. The influence of a HF-rTMS treatment on the CMT was examined. Subsequently, the CMT was measured under sedation and general anaesthesia. Finally, the coil-cortex distance was associated with the CMT, weight, age and gender. During one year the CMT was measured three times, during which it remained constant, although a higher CMT was measured (40% higher machine output) when using EMG (P-value < .001) and under general anaesthesia (P-value = .005). On average, a 40% and 12% higher machine output were registered. An aHF-rTMS protocol does not influence the CMT. Males have on average a 5.2 mm larger coil cortex distance and an 11.81% higher CMT. The CMT was positively linearly associated (P-value < .05) with the weight and age of the animals. Only within female subjects, a positive linear association was found between the CMT and the coil-cortex distance (P-value = .02). Using the visual Rossini paradigm, the CMT can be reliably used over time and during a TMS treatment. It has to be kept in mind that when using EMG or assessing the CMT under general anaesthesia, a higher CMT is to be expected. As in humans, every parameter that influences the coil-cortex distance may also influence the CMT.

Changes in canine cerebral perfusion after accelerated high frequency repetitive transcranial magnetic stimulation (HF-rTMS): A proof of concept study.

Repetitive transcranial magnetic stimulation (rTMS) has been proposed as a treatment for several neuropsychiatric disorders in human beings, but the neurobiological effects of rTMS in dogs have not been investigated to date. A proof of concept study was designed to evaluate the effect of rTMS on cerebral perfusion, measured with single photon emission computed tomography (SPECT), in dogs. An accelerated high frequency (aHF)-rTMS (20Hz) protocol was applied to the canine left frontal cortex. To accurately target this area, eight dogs underwent a 3 Tesla magnetic resonance imaging (MRI) scan before stimulation. The left frontal cortex was subjected to five consecutive aHF-rTMS sessions with a figure-of-eight coil designed for human beings at an intensity of 110% of the motor threshold. The dogs underwent 99mTc-d,1 hexamethylpropylene amine oxime (HMPAO) SPECT scans 1 week prior to and 1day after the stimulations. Perfusion indices (PIs) were determined semi-quantitatively; aHF-rTMS resulted in significantly increased PIs in the left frontal cortex and the subcortical region, whereas no significant differences were noted for the other regions. Behaviour was not influenced by the stimulation sessions. As has been observed in human beings, aHF-rTMS applied to the left frontal cortex alters regional cerebral perfusion in dogs.

Contrast-Enhanced Ultrasound Examination for the Assessment of Renal Perfusion in Cats with Chronic Kidney Disease.

BACKGROUND: Contrast-enhanced ultrasound examination (CEUS) is a functional imaging technique allowing noninvasive assessment of tissue perfusion. Studies in humans show that the technique holds great potential to be used in the diagnosis of chronic kidney disease (CKD). However, data in veterinary medicine are currently lacking. OBJECTIVES: To evaluate renal perfusion using CEUS in cats with CKD. ANIMALS: Fourteen client-owned cats with CKD and 43 healthy control cats. METHODS: Prospective case-controlled clinical trial using CEUS to evaluate renal perfusion in cats with CKD compared to healthy control cats. Time-intensity curves were created, and perfusion parameters were calculated using off-line software. A linear mixed model was used to examine differences between perfusion parameters of cats with CKD and healthy cats. RESULTS: In cats with CKD, longer time to peak and shorter mean transit times were observed for the renal cortex. In contrast, a shorter time to peak and rise time were seen for the renal medulla. The findings for the renal cortex indicate decreased blood velocity and shorter total duration of enhancement, likely caused by increased vascular resistance in CKD. Increased blood velocity in the renal medulla has not been described before and may be because of a different response to regulatory factors in cortex and medulla. CONCLUSIONS AND CLINICAL IMPORTANCE: Contrast-enhanced ultrasound examination was capable of detecting perfusion changes in cats with CKD. Further research is warranted to assess the diagnostic capabilities of CEUS in early stage of the disease process.

Evaluation of Renal Perfusion in Hyperthyroid Cats before and after Radioiodine Treatment.

BACKGROUND: Hyperthyroidism and chronic kidney disease (CKD) are common in elderly cats. Consequently, both diseases often occur concurrently. Furthermore, renal function is affected by thyroid status. Because changes in renal perfusion play an important role in functional renal changes in hyperthyroid cats, investigation of renal perfusion may provide novel insights. OBJECTIVES: To evaluate renal perfusion in hyperthyroid cats with contrast-enhanced ultrasound (CEUS). ANIMALS: A total of 42 hyperthyroid cats was included and evaluated before and 1 month after radioiodine treatment. METHODS: Prospective intrasubject clinical trial of contrast-enhanced ultrasound using a commercial contrast agent (SonoVue) to evaluate renal perfusion. Time-intensity curves were created, and perfusion parameters were calculated by off-line software. A linear mixed model was used to examine differences between pre- and post-treatment perfusion parameters. RESULTS: An increase in several time-related perfusion parameters was observed after radioiodine treatment, indicating a decreased blood velocity upon resolution of the hyperthyroid state. Furthermore, a small post-treatment decrease in peak enhancement was present in the renal medulla, suggesting a lower medullary blood volume. CONCLUSIONS AND CLINICAL IMPORTANCE: Contrast-enhanced ultrasound indicated a higher cortical and medullary blood velocity and higher medullary blood volume in hyperthyroid cats before radioactive treatment in comparison with 1-month post-treatment control.

Postoperative survival following perioperative MAGIC versus neoadjuvant OE02-type chemotherapy in oesophageal adenocarcinoma.

The optimal management of resectable oesophageal adenocarcinoma is controversial, with many centres using neoadjuvant chemotherapy following the Medical Research Council (MRC) oesophageal working group (OE02) trial and the MRC Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial. The more intensive MAGIC regimen is used primarily in gastric cancer but some also use it for oesophageal cancer. A database of cancer resections (2001-2013) provided information on survival of patients following either OE02 or MAGIC-type treatment. The data were compared using Kaplan-Meier analysis. Straight-to-surgery patients were also reviewed and divided into an 'early' cohort (2001-2006, OE02 era) and a 'late' cohort (2006-2013, MAGIC era) to estimate changes in survival over time. Subgroup analysis was performed for responders (tumour regression grade [TRG] 1-3) versus non-responders (TRG 4 and 5) and for anatomical site (gastro-oesophageal junction [GOJ] vs oesophagus). An OE02 regimen was used for 97 patients and 275 received a MAGIC regimen. Those in the MAGIC group were of a similar age to those undergoing OE02 chemotherapy but the proportion of oesophageal cancers was higher among MAGIC patients than among those receiving OE02 treatment. MAGIC patients had a significantly lower stage following chemotherapy than OE02 patients and a higher median overall survival although TRG was similar. On subgroup analysis, this survival benefit was maintained for GOJ and oesophageal cancer patients as well as non-responders. Analysis of responders showed no difference between regimens. 'Late' group straight-to-surgery patients were significantly older than those in the 'early' group. Survival, however, was not significantly different for these two cohorts. Although the original MAGIC trial comprised few oesophageal cancer cases, our patients had better survival with MAGIC than with OE02 chemotherapy in all anatomical subgroups, even though there was no significant change in operative survival over the time period in which these patients were treated. The use of the MAGIC regimen should therefore be encouraged in cases of operable oesophagogastric adenocarcinoma.

Magnetic Resonance Imaging of the Dorsal Proximal Synovial Plica of the Equine Metacarpo-/Metatarsophalangeal Joint.

A synovial plica is present at the dorsoproximal aspect of the fetlock joint. The objective of this study was to describe the location of the synovial plica during induced hyperextension using Magnetic Resonance Imaging. For this study 20 cadaver limbs from five Warmblood horses were used. Measurements were made of the dorsal; palmar/plantar length and the thickness of the plica with the joint in a normal position. During induced hyperextension of the joint, the position of the plica was described; the dorsal angle of extension and angle of contact between the proximal phalanx (P1) and the condyle were measured. The dorsal length differed between front/hind limbs and between the medial/lateral aspect of the joint. The angle of contact between P1 and condyle differed between front/hind limbs; between the lateral and medial aspect of the joint and between different positions of the plica. Four different positions of the plica were observed: shortened with the tip curved towards palmar/plantar; projecting distally; projecting towards dorsal and projecting distally with the tip interposed between P1 and the condyle. During induced hyperextension, a close relation is present between the synovial plica, P1 and the condyle with a variable position of the plica; which is suggestive for a contact interface between P1 and the metacarpal/metatarsal bone. However the plica does not seem to act consistently as a cushioning surface.

Computational fluid dynamics modeling of Bacillus anthracis spore deposition in rabbit and human respiratory airways.

Three-dimensional computational fluid dynamics and Lagrangian particle deposition models were developed to compare the deposition of aerosolized Bacillus anthracis spores in the respiratory airways of a human with that of the rabbit, a species commonly used in the study of anthrax disease. The respiratory airway geometries for each species were derived respectively from computed tomography (CT) and µCT images. Both models encompassed airways that extended from the external nose to the lung with a total of 272 outlets in the human model and 2878 outlets in the rabbit model. All simulations of spore deposition were conducted under transient, inhalation-exhalation breathing conditions using average species-specific minute volumes. Two different exposure scenarios were modeled in the rabbit based upon experimental inhalation studies. For comparison, human simulations were conducted at the highest exposure concentration used during the rabbit experimental exposures. Results demonstrated that regional spore deposition patterns were sensitive to airway geometry and ventilation profiles. Due to the complex airway geometries in the rabbit nose, higher spore deposition efficiency was predicted in the nasal sinus compared to the human at the same air concentration of anthrax spores. In contrast, higher spore deposition was predicted in the lower conducting airways of the human compared to the rabbit lung due to differences in airway branching pattern. This information can be used to refine published and ongoing biokinetic models of inhalation anthrax spore exposures, which currently estimate deposited spore concentrations based solely upon exposure concentrations and inhaled doses that do not factor in species-specific anatomy and physiology for deposition.

Diagnostic imaging and endoscopic finding in dogs and cats with gastric tumors: a review.

Medical imaging is an essential part of the diagnostic workup of many gastrointestinal disorders. This paper reviews imaging and endoscopy of gastric tumors in dogs and cats and the techniques used. The appearance of the normal as well as the various aspects of gastric tumors are described for these different modalities. Plain radiography is widely available but has limited diagnostic value. Contrast radiography has higher sensitivity but is laborious and time-consuming. Ultrasonography (if an adequate acoustic window is available), endosonography and endoscopy are the most appropriate modalities for diagnosing gastric tumors. They are especially useful when obtaining samples for cytologic or histopathologic examination, because the imaging modalities do not always differentiate between inflammatory or infectious conditions and neoplastic disorders. Hydro-helical CT was found helpful for evaluating the location and local invasiveness of the lesion. Ultrasonography and endoscopy are useful modalities for taking adequate biopsies.

L'imagerie diagnostique est un élément important du diagnostic de nombreuses affections gastro-intestinales. Cet article donne un aperçu des diverses techniques d'imagerie qui peuvent être utilisées pour identifier des tumeurs gastriques chez le chien et le chat. On décrit aussi bien les aspects physiologiques que les altérations pathologiques. Des clichés radiographiques sont en général facilement disponibles, ils n'ont toutefois qu'une valeur diagnostique limitée. Les études utilisant des moyens de contraste ont une meilleure valeur diagnostique mais nécessitent du temps et de travail. L'échographie (pour autant qu'on dispose d'une fenêtre acoustique adéquate), l'endosonographie et l'endoscopie sont les techniques diagnostiques les plus sûres pour identifier les tumeurs gastriques. Comme les techniques d'imagerie ne permettent pas toujours de différencier entre inflammation et tumeur, elles sont particulièrement utiles pour prélever des échantillons pour la cytologie ou l'histopathologie. Le scanner hydro-hélical est utile pour définir la localisation et l'extension d'une lésion, alors que l'échographie et l'endoscopie servent avant tout à effectuer des biopsies adéquates.

The effects of positioning, reason for screening and the referring veterinarian on prevalence estimates of canine hip dysplasia.

Although the prevalence of canine hip dysplasia (HD) has been the subject of a number of published studies, estimates vary widely. This study evaluated several possible causes for these differences. Sixty Belgian, Dutch and German veterinarians were asked to submit all hip radiographs obtained for screening purposes (irrespective of HD status) over a 2-year period, resulting in a database of 583 dogs. Each set of radiographs was accompanied by information on the reason for screening (breeding soundness examination, clinical complaint, assistance dogs, or other reasons), and dog breed, date of birth and age. Dog positioning exerted an effect at multiple levels. The agreement among different observers regarding correct or incorrect positioning was limited and incorrect positioning itself reduced the inter-observer agreement for radiographic hip conformation. Dysplastic dogs were more commonly positioned incorrectly than non-dysplastic dogs. The clinical complaint population had a high prevalence of dysplastic dogs (>70%) compared with the breeding population (11%) and the assistance dogs (6%). There was a significantly lower prevalence of HD among cases referred by veterinarians who frequently submitted hip-extended radiographs for evaluation (P = 0.002) compared to those who refer less frequently. However, this was likely to be selection bias, as radiographs that were from dogs suspected to be dysplastic were not submitted by frequent senders. The prevalence of dysplastic dogs varied widely between breeds (16.7-71.4%). Dogs diagnosed with dysplasia were significantly older than dogs considered healthy (P = 0.001) and dogs classified as borderline dysplastic (P = 0.035). Inter-observer agreement for hip conformation was moderately low, resulting in >7% variation in prevalence estimates for dysplasia.

Description of the use of contrast-enhanced ultrasonography in four dogs with pancreatic tumours.

Canine pancreatic tumours are rare compared to human medicine and the detection and differentiation of pancreatic neoplasia is challenging with B-mode ultrasonography, which often leads to late clinical diagnosis and poor prognosis. This case report describes the findings of contrast-enhanced ultrasonography in four dogs with pancreatic adenocarcinoma or insulinoma. B-mode ultrasonography of the pancreas revealed a hypoechoic nodule in three dogs and heterogenous tissue in one dog. Contrast-enhanced ultrasonography was able to differentiate between two tumour types: adenocarcinomas showed hypoechoic and hypovascular lesions, whereas insulinomas showed uniformly hypervascular lesions. Contrast-enhanced ultrasonography findings were confirmed by cytology and/or histopathology. The results demonstrated that contrast-enhanced ultrasonography was able to establish different enhancement patterns between exocrine (adenocarcinoma) and endocrine (insulinoma) tumours in dogs.

Computed tomographic anatomy of the equine foot.

This study describes a detailed computed tomographic reference of the normal equine foot. Ten forefeet of five adult cadavers, without evidence of orthopaedic disease, were used. Computed tomography (CT) was performed on all feet. Two-millimetre thick transverse slices were obtained, and sagittal and dorsal planes were reformatted. The CT images were matched with the corresponding anatomic slices. The phalanges and the distal sesamoid bone showed excellent detail. The extensor and flexor tendons (including their attachments) could be clearly evaluated. The collateral (sesamoidean) ligaments could be readily located, but were difficult to delineate at their proximal attachment. The distal digital annular ligament could only be distinguished from the deep digital flexor tendon proximal to the distal sesamoid bone, and its proximal attachment could be identified, but not its distal insertion. Small ligaments (impar ligament, chondrosesamoidean, chondrocoronal and chondrocompedal ligaments, axial and abaxial palmar ligaments of the proximal inter-phalangeal joint) were seen with difficulty and not at all slices. The joint capsules could not be delineated from the surrounding soft tissue structures. The lateral and medial proprius palmar digital artery and vein could be visualized occasionally on some slices. The ungular cartilages, corium and hoof wall layering were seen. The nerves, the articular and fibrocartilage of the distal sesamoid bone and the chondroungular ligament could not be assessed. Computed tomography of the equine foot can be of great value when results of radiography and ultrasonography are inconclusive. Images obtained in this study may serve as reference for CT of the equine foot.

Computed tomographic features of lesions detected in horses with tarsal lameness.

REASONS FOR PERFORMING STUDY: Tarsal pain is a common cause of hindlimb lameness in horses. Diagnosis can usually be made with radiography and ultrasonography; however, in some cases, these techniques are inconclusive and additional imaging is necessary. No studies describing computed tomography (CT) features of different tarsal lesions in horses with tarsal lameness are reported. OBJECTIVES: Our aims were as follows: 1) to characterise CT abnormalities in horses with tarsal lameness; 2) to compare CT findings with those from other imaging techniques; and 3) to assess whether CT can help to diagnose tarsal pathology. STUDY DESIGN: Retrospective case series. METHODS: Computed tomography of the tarsus was performed on 15 horses (n = 17 joints) with tarsal lameness. The horses were divided into 3 groups depending on the reason for CT examination, as follows: 1) other imaging techniques were inconclusive; 2) evaluation of a fracture; or 3) other imaging techniques showed tarsal lesions, and CT was performed to assess whether additional lesions were present. RESULTS: Group 1 included 7 horses. Lesions detected with CT included subchondral cyst-like lesions (2 horses); an osteolytic lesion in the cochlea tibiae (one horse); degenerative changes of the distal tarsal joints (2 horses); osteolytic lesions tarsometatarsal joint (one horse); and sclerosis of the third tarsal bone with a lesion of the tarsometatarsal interosseous ligament (one horse). In this group, CT provided information on the character and extent of the lesion that was not available with other imaging techniques. Computed tomography revealed more information about the extent and complexity of the fracture than radiography in Group 2, whereas CT did not provide extra information in Group 3. CONCLUSIONS: Focal lesions located between the tarsal bone surfaces are difficult or even impossible to detect with radiography and ultrasonography, but they can be detected and characterised with CT. POTENTIAL RELEVANCE: Computed tomography of the tarsus should be considered when radiography and ultrasonography are inconclusive, or for further evaluation of tarsal fractures.

Colorectal cancer is reliably excluded in the frail and elderly population by minimal preparation CT.

BACKGROUND: This study aimed to retrospectively assess the accuracy of minimal preparation computed tomography (MPCT) in the detection of colorectal cancer (CRC) within the frail and elderly population and to evaluate the relevance of extra-colonic findings (ECF). METHODS: Radiology reports, clinical notes and follow-up reports from 207 patients who underwent MPCT to investigate for CRC between 2005 and 2009 were analysed. Patients were scanned following the administration of oral contrast for 48 h, without bowel preparation or colonic insufflation. MPCT results were measured against patient outcomes, with a minimum of 2 years of follow-up. RESULTS: Twelve cases of clinically relevant CRC were confirmed (5.8 %). MPCT correctly identified 11 of these lesions (sensitivity 91.6 %). Thirty-one patients had a possible CRC identified by MPCT, which was not confirmed by further examination (specificity 84.1 %). This results in a positive predictive value of 26.2 % and a negative predictive value of 99.4 %. Five of the patients with colon cancer underwent curative surgery. Sixty-eight clinically relevant ECF were confirmed, including 14 previously undiagnosed extra-colonic malignancies. ECF were considered to account for the presenting complaint in 15.0 % (31/207) of all patients. CONCLUSIONS: Minimal preparation computed tomography is an effective and reliable investigation for the exclusion of clinically relevant CRC in this population. It provides clinicians with a valuable and pragmatic alternative to colonoscopy and CT colonography when invasive examination or cathartic bowel preparation will be poorly tolerated and small polyps are of limited significance. MPCT has an advantage over purely luminal imaging in the detection of extra-colonic pathology and appears to have an equally important role in the detection of CRC.

Clinical, radiographic, ultrasonographic and computed tomographic features of nonseptic osteitis of the axial border of the proximal sesamoid bones.

REASONS FOR PERFORMING STUDY: Lysis of the axial aspect of equine proximal sesamoid bones (PSBs) is a rare condition reported to have septic or traumatic origins. Limited information exists regarding imaging of nonseptic axial osteitis of a PSB. OBJECTIVES: To report the clinical, radiographic, ultrasonographic, computed tomographic and intra-arterial contrast-enhanced computed tomographic abnormalities in horses with axial nonseptic osteitis of a PSB. STUDY DESIGN: Retrospective clinical study. METHODS: Eighteen horses diagnosed with nonseptic osteitis of the axial border of a PSB between 2007 and 2012 were reviewed retrospectively. Case details, clinical examination, radiographic, ultrasonographic, computed tomographic and intra-arterial/intra-articular contrast-enhanced computed tomographic features were recorded, when available. Radiographic, ultrasonographic and computed tomographic evaluations of the fetlock region had been performed on 18, 15 and 9 horses, respectively. The effect of the degree of lysis on the grade and duration of lameness was determined. RESULTS: All horses had chronic unilateral lameness, 4 with forelimb and 14 with hindlimb signs. On radiographs, lysis was identified in both PSBs in 14 horses, one PSB in 3 horses and in one horse no lysis was identified. The degree of osteolysis was variable. Ultrasonography identified variably sized irregularities of the bone surface and alteration in echogenicity of the palmar/plantar ligament (PL). All horses undergoing computed tomographic examination (n = 9) had biaxial lysis. The lesions were significantly longer and deeper on computed tomographic images compared with radiographic images. Intra-arterial contrast-enhanced computed tomography may reveal moderate to marked contrast enhancement of the PL. There was no significant effect of the degree of lysis on the grade and duration of lameness. CONCLUSIONS: Lesions of nonseptic axial osteitis of a PSB can be identified using a combination of radiography and ultrasonography. Computed tomography provides additional information regarding the extent of the pathology.

A review of diagnostic imaging of snakes and lizards.

Snakes and lizards are considered 'stoic' animals and often show only non-specific signs of illness. Consequently, diagnostic imaging--along with clinical examination and laboratory tests--is gaining importance in making a final diagnosis and establishing a correct therapy. The large number of captive snake and lizard species commonly kept as pets, together with the high inter- and intraspecific morphological variability that is innate in these animals, make the analysis of diagnostic images challenging for the veterinary practitioner. Moreover, a thorough knowledge of the anatomy, physiology and pathology of the species that are the object of clinical investigation is mandatory for the correct interpretation of diagnostic images. Despite the large amount of clinical and scientific work carried out in the past two decades, the radiographic features of snakes and lizards have not undergone systematic description, and therefore veterinarians often have to rely mostly on anatomical studies rather than radiological literature. The aim of this paper is to review the most commonly used diagnostic imaging modalities, as well as to provide an overview of the available international original studies and scientific reviews describing the normal and pathological imaging features in snakes and lizards.

Primary and concomitant flexor enthesopathy of the canine elbow.

OBJECTIVES: To report the characteristics of two types of flexor enthesopathy, primary and concomitant, based on different diagnostic techniques. MATERIALS AND METHODS: Over a period of three years a prospective study was performed on dogs admitted for the complaint of elbow lameness. Based on the radiographic findings a selection of dogs underwent a complete series of different imaging modalities. With each technique, pathology of the medial epicondyle and the presence of other elbow disorders were recorded. All joints with signs of flexor pathology apparent with at least three techniques were selected. A distinction was made between primary and concomitant flexor enthesopathy based on the absence or presence of other elbow disorders. RESULTS: Primary flexor enthesopathy was diagnosed in 23 joints and concomitant flexor enthesopathy in 20 joints. In 43% of the joints with primary and in 75% of the joints with concomitant flexor enthesopathy, pathology at the medial epicondyle was demonstrated by all techniques. All joints with concomitant flexor enthesopathy had a diagnosis of medial coronoid disease, osteochondritis dissecans, or both. CLINICAL SIGNIFICANCE: Pathology at the medial epicondyle is a sign of flexor enthesopathy. It may be present as the only sign in a joint with primary flexor enthesopathy or concomitant with other elbow pathology. In both groups flexor lesions can be demonstrated with different imaging techniques. The distinction between the primary and concomitant form is based on the presence or absence of other elbow pathology, mainly medial coronoid disease. Recognizing both types is important for a correct treatment decision.

The use of planar bone scintigraphy and HiSPECT for diagnosis of primary and concomitant flexor enthesopathy in the canine elbow.

OBJECTIVE: To investigate the possibilities and limitations of planar bone scintigraphy and high resolution single photon emission computed tomography (HiSPECT) to diagnose flexor enthesopathy and to distinguish primary flexor enthesopathy from the concomitant form. MATERIALS AND METHODS: A prospective study of 46 dogs with primary flexor enthesopathy, concomitant flexor enthesopathy, medial coronoid disease, and normal elbows was performed. All dogs underwent planar bone scintigraphy and HiSPECT imaging. The obtained images were visually scored for increased radiopharmaceutical uptake in the medial humeral epicondylar and medial coronoid process region using a score from 1-3. RESULTS: Planar bone scintigraphy demonstrated increased radiopharmaceutical uptake in all diseased elbow joints, except for one. HiSPECT demonstrated increased radiopharmaceutical uptake of the medial humeral epicondyle in nearly all clinically affected joints with primary and concomitant flexor enthesopathy. Additional uptake of the medial coronoid process was recorded in all clinically affected joints with concomitant flexor enthesopathy and in six out of 18 with primary flexor enthesopathy. No difference in intensity of the uptake was noticed. CLINICAL SIGNIFICANCE: Planar bone scintigraphy allows the attribution of lameness to the elbow joint in cases of primary flexor enthesopathy with minimal or even absent radiographic changes. The more detailed HiSPECT enables the localization of pathology within the elbow joint and is a sensitive technique to detect flexor enthesopathy. However HiSPECT is insufficient to distinguish primary from concomitant flexor enthesopathy.