Associations between biochemical parameters and referral centre in pet rabbits with urolithiasis.

OBJECTIVES: To determine the association between signalment, selected haematologic and biochemical parameters and referral centre in pet rabbits with imaging evidence of urolithiasis presented to two veterinary teaching hospitals in North America. MATERIALS AND METHODS: The medical record database of two veterinary teaching hospitals was searched from 2009 to 2019 for records of pet rabbits that received both imaging studies and plasma biochemistry profiles. Information regarding signalment, bodyweight, packed cell volume, total solids, and plasma biochemistry profiles was obtained. Univariable and multivariable logistic regression models were performed to identify statistically significant parameters associated with imaging evidence of urolithiasis. RESULTS: Of the 324 examined rabbits, 33 (10.2%) had confirmed evidence of urolithiasis on imaging. Increasing plasma calcium and sodium concentrations and referral centre were significantly associated with the presence of urolithiasis on the univariable logistic regression model. However, only plasma calcium concentration and the referral centre demonstrated significant associations on the multivariable logistic regression model. CLINICAL SIGNIFICANCE: Results indicate that urolithiasis in pet rabbits that receive imaging is associated with mildly increasing plasma calcium concentration and referral centre. The association with referral centre may indicate there are geographic influences on urolithiasis or on imaging. However, the identified associations have low predictive value for the diagnosis of urolithiasis, indicating the need for additional diagnostic modalities.

Specific class of intrapartum antibiotics relates to maturation of the infant gut microbiota: a prospective cohort study.

OBJECTIVE: To evaluate the potential impact of intrapartum antibiotics, and their specific classes, on the infant gut microbiota in the first year of life. DESIGN: Prospective study of infants in the New Hampshire Birth Cohort Study (NHBCS). SETTINGS: Rural New Hampshire, USA. POPULATION OR SAMPLE: Two hundred and sixty-six full-term infants from the NHBCS. METHODS: Intrapartum antibiotic use during labour and delivery was abstracted from medical records. Faecal samples collected at 6 weeks and 1 year of age were characterised by 16S rRNA sequencing, and metagenomics analysis in a subset of samples. EXPOSURES: Maternal exposure to antibiotics during labour and delivery. MAIN OUTCOME MEASURE: Taxonomic and functional profiles of faecal samples. RESULTS: Infant exposure to intrapartum antibiotics, particularly to two or more antibiotic classes, was independently associated with lower microbial diversity scores as well as a unique bacterial community at 6 weeks (GUnifrac, P = 0.02). At 1 year, infants in the penicillin-only group had significantly lower α diversity scores than infants not exposed to intrapartum antibiotics. Within the first year of life, intrapartum exposure to penicillins was related to a significantly lower increase in several taxa including Bacteroides, use of cephalosporins was associated with a significantly lower rise over time in Bifidobacterium and infants in the multi-class group experienced a significantly higher increase in Veillonella dispar. CONCLUSIONS: Our findings suggest that intrapartum antibiotics alter the developmental trajectory of the infant gut microbiome, and specific antibiotic types may impact community composition, diversity and keystone immune training taxa. TWEETABLE ABSTRACT: Class of intrapartum antibiotics administered during delivery relates to maturation of infant gut microbiota.

Rapid assessment of postural instability in Parkinson's disease (RAPID): a pilot study.

BACKGROUND: The Fahn's pull (or retropulsion) test is an item in the motor section of the Unified Parkinson's Disease Rating Scale, which is used almost exclusively to classify postural instability in Parkinson's disease (PD). However, the test is hard to standardize and is often performed incorrectly, making it hard to interpret. Moreover, it may not be safe to administer in patients who experience pain in the shoulders, neck, trunk and/or lower extremities. Identifying and grading postural instability in PD without requiring a physical challenge would not only be useful for the clinician but would assist patients and caregivers in its recognition. We propose the use of the rapid assessment of postural instability in Parkinson's disease (RAPID) questionnaire as a non-physical assessment tool. METHODS: We determined the associations between the pull test and items on a risk-assessment questionnaire that consisted of three parts: activities of daily living, fear of falling, and frequency of falling. RESULTS: Significant correlations were found between the pull test and the predictor variables, which ranged between 0.51 and 0.56 whilst the correlations amongst the predictor variables ranged between 0.58 and 0.70. The three parts of the questionnaire, when used in combination, produced a 96% sensitivity in the classification of postural instability. CONCLUSIONS: The RAPID questionnaire can be used as an adjunct to the pull test or solely if the pull test is contraindicated. It may also be possible to administer the questionnaire via the telephone or Internet. It is hoped that the rapid identification of postural instability would lead to fewer falls.

Sonographically guided intratendinous injections of hyperosmolar dextrose/lidocaine: a pilot study for the treatment of chronic plantar fasciitis.

OBJECTIVE: To report on the effectiveness of sonographically guided injections of hyperosmolar dextrose at reducing the pain associated with chronic plantar fasciitis. DESIGN: Case series. SETTING: Ultrasound division of St Paul's Hospital. PATIENTS: 20 referrals (3 men, 17 women; age 51 (SD 13) years) from local sports medicine primary care practitioners who had failed previous conservative treatments. INTERVENTIONS: A 27-gauge needle administered a 25% dextrose/lidocaine solution under sonographic guidance at 6 week intervals returning for a median of three consultations. MAIN OUTCOME MEASURES: Visual analogue scale (VAS) items for pain levels at rest (VAS1), activities of daily living (VAS2), and during or after physical activity (VAS3) were recorded at baseline and at the final treatment consultation (post-test). A telephone interview conducted an average of 11.8 months after the post-test consultation provided a measure of long-term follow-up. RESULTS: 16 patients reported a good to excellent outcome, while the symptoms in 4 patients were unchanged. There was a significant decrease (p<0.001) in all mean VAS items from pre-test to post-test: VAS1 (36.8 (SD 25.6) to 10.3 (10.9)), VAS2 (74.7 (20.8) to 25.0 (27.7)) and VAS3 (91.6 (9.2) to 38.7 (35.1)) and there were no apparent changes after the follow-up interview. CONCLUSIONS: Sonographically guided dextrose injections showed a good clinical response in patients with chronic plantar fasciitis insofar as pain was reduced during rest and activity. Further studies including a control group are needed to validate these outcomes.

Oblique sagittal view of the anterior cruciate ligament: comparison of coronal vs. axial planes as localizing sequences.

The purpose of this study was to determine whether oblique sagittal T2-weighted images of the anterior cruciate ligament (ACL) are better prescribed off axial or coronal localizing images. Thirty-one patients underwent two sets of oblique sagittal T2-weighted fast spin-echo sequences to evaluate the ACL. One oblique was prescribed from a coronal localizing sequence, while the other was prescribed off an axial series. Objective (average number of images to demonstrate ACL) and subjective (radiologist's confidence level) evaluations of both sequences were performed independently of the other and then comparatively by two radiologists. The coronally prescribed sagittal oblique was subjectively preferred in 18 patients, the axially prescribed oblique was preferred in one patient, and both sequences were felt to be equivalent in 12 patients. In 13 intact ligaments, the average number of images clearly demonstrating the entire length of the ACL was 1.77 on the coronally prescribed sequence and 1.31 on the axially prescribed images. Oblique sagittal images prescribed off a coronal localizer are both subjectively and objectively more effective than axially prescribed sagittal obliques in evaluating the ACL.

Real-time spatial compound imaging: application to breast, vascular, and musculoskeletal ultrasound.

Real-time spatial compound imaging (SonoCT) is an ultrasound technique that uses electronic beam steering of a transducer array to rapidly acquire several (three to nine) overlapping scans of an object from different view angles. These single-angle scans are averaged to form a multiangle compound image that is updated in real time with each subsequent scan. Compound imaging shows improved image quality compared with conventional ultrasound, primarily because of reduction of speckle, clutter, and other acoustic artifacts. Early clinical experience suggests that real-time spatial compound imaging can provide improved contrast resolution and tissue differentiation that is beneficial for imaging the breast, peripheral blood vessels, and musculoskeletal injuries. Future development of real-time spatial compound imaging will help address the bulk of general imaging applications by extending this technology to curved array transducers, tissue harmonics, panoramic imaging, and three-dimensional sonography.

Stratification of prostate-specific antigen level and results of transrectal ultrasonography and digital rectal examination as predictors of positive prostate biopsy.

OBJECTIVE: To determine which of several variables--age, serum level of prostate-specific antigen (PSA), findings of transrectal ultrasonography (TRUS) and findings of digital rectal examination (DRE)--are the best predictors of positive prostate biopsy results. SETTING: An urban, university-affiliated tertiary care hospital. PATIENTS: a cohort of 1330 consecutive men referred to the diagnostic imaging department for TRUS and TRUS-guided prostate biopsy. Each patient was referred after examination by a urologist because of clinical suspicion of prostate cancer. METHODS: All of the men had undergone prior determination of serum level of PSA. Repeat DRE was performed at the time of imaging. The variables age, PSA level, TRUS findings and DRE findings were tested aline and in combination as predictors of positive biopsy results by means of logistic regression analysis. A summary of percentage risk for positive biopsy results was constructed for each combination of statistically significant variables, stratified for age. RESULTS: Cancer was detected in 541 men (40.7%). A strong correlation was observed between serum PSA level and the likelihood of positive biopsy result (p < 0.001). Of 402 men with normal age-specific PSA, 109 (27.1%) had positive biopsy results. Of 403 men with PSA of 10 ng/mL or more, 233 (57.8%) had cancer. The level of serum PSA was also related to the number of prostate sextants harbouring cancer (p < 0.001). TRUS findings at the time of biopsy were a strong predictor of cancer of the PSA level was abnormal (p < 0.001). DRE results alone did not correlate with positive biopsy results, regardless of age, PSA level of TRUS findings. CONCLUSIONS: Men in whom there is a clinical concern for prostate cancer should undergo prostate biopsy if there is any elevation of age-specific PSA, particularly if the findings of TRUS are also abnormal. Because DRE alone was not predictive of biopsy outcome, algorithms for prostate cancer detection that rely on abnormal DRE results to identify men who should undergo biopsy will miss a significant number of cancers.

Effect of hyoscine butylbromide on gastroesophageal reflux in barium studies of the upper gastrointestinal tract.

Hyoscine butylbromide (Buscopan) is an intravenously administered hypotonic agent that significantly reduces pressure in the lower esophageal sphincter and may therefore artificially induce gastroesophageal reflux during barium examination of the upper gastrointestinal tract. This study was performed to test this hypothesis. The presence or absence and severity of gastroesophageal reflux before and after intravenous injection of 20 mg Buscopan were evaluated in 112 consecutive patients undergoing biphasic upper gastrointestinal examination. Gastroesophageal reflux was seen in 49 (44%) of the patients. Reflux was evident both before and after the injection of Buscopan in 35 (31%) of the patients, before injection only in 10 (9%) and after injection only in 4 (4%). The magnitude of reflux after injection of Buscopan was reduced or the same in 108 of the patients (96%) and increased in 4 (4%). There was no significant difference in the overall occurrence (p = 0.41) or degree (p = 0.81) of gastroesophageal reflux before and after injection of Buscopan (chi 2 test). The authors conclude that the routine use of Buscopan is unlikely to spuriously increase the frequency or degree of gastroesophageal reflux observed on upper gastrointestinal barium studies.

Systematic transrectal ultrasound-guided biopsy of the prostate.

This study was undertaken to confirm the utility of systematic transrectal ultrasound-guided prostate biopsy in diagnosing cancer in patients with abnormal findings on digital rectal examination or abnormal levels of prostate-specific antigen (or both). The authors also wanted to determine the diagnostic advantage of taking six sextant biopsy samples rather than four quadrant samples. In a prospective study of 669 men examined between July 1992 and April 1993 at a tertiary-care hospital, core samples were obtained from any visualized or palpated abnormalities, the three other "normal" quadrants (apices and bases) and the two parasagittal midzones. The glands of 403 of the patients (60%) had an abnormality detectable by ultrasonography, and 233 of the patients (35%) had adenocarcinoma, proven by histologic examination. Of the 169 cases of adenocarcinoma initially indicated by ultrasonography, the suspected lesion was histologically benign in 66 (39%), but malignancy was found in another portion of the gland. In 18 (8%) of the 233 patients with adenocarcinoma, the only positive result was obtained from the additional core biopsy samples from the midzone. This study confirms that the ultrasonographic characteristics of cancer are variable, that many tumours (130 [56%] in this study) are detected in areas that are normal on ultrasonography and digital rectal examination, and that the detection sensitivity is increased (by 8% in this study) when two midlobe parasagittal plane biopsy samples are added to the four standard quadrant samples.

Differentiation of detached retina and vitreous membrane with color flow Doppler.

The sonographic criteria for diagnosis of retinal detachment and vitreous membranes are well established, and in most cases a diagnosis can be made. However, in difficult cases, differentiation between the two may be difficult. In this study the use of high-resolution color flow Doppler was evaluated for differentiating between retinal detachments and vitreous membranes. Sonographic evaluation, including color flow Doppler, was performed in 25 symptomatic eyes. Seven eyes had areas of retinal detachment, all of which had detectable blood flow within at least a portion of the detached retina. Fifteen eyes had vitreous hemorrhages or membranes in which no flow was detected. Two diabetic patients with vitreous membranes and no retinal detachment did have flow detectable within the neovascular membranes. Another patient, who had a complete choroid detachment after surgery, demonstrated good flow within the area of detachment. It is concluded that in difficult cases high-resolution color flow Doppler can enable differentiation of an area of retinal detachment from a vitreous membrane in a patient without diabetes.

The "coffee bean" sign in periappendiceal and peridiverticular abscess.

Four cases of right lower quadrant abscess, each a clinical diagnostic dilemma, were recognized as abscesses surrounding a perforated viscus by application of the "coffee bean" sign on sonographic examination. The appearance in the right lower quadrant of a brightly echogenic finger-like projection extending into a cystic mass, with or without scattered internal echoes, should suggest the possibility of periappendiceal or diverticular abscess.