Choosing the best method to utilise single positron emission computed tomography (SPECT) scans in the management of unilateral condylar hyperplasia.

Facial asymmetry secondary to unilateral condylar hyperplasia can be a diagnostic challenge to oral and maxillofacial surgeons. Single positron emission computed tomography (SPECT) scans provide a useful adjunct. We report a brief summary of the evidence describing the effectiveness of different methods of analysing SPECT scans and compare it with the results of a 10-year study at Sunderland Royal Hospital. Overall, both the evidence base and our study strongly favour use of the condyle:condyle ratio over the condyle:reference bone ratio, suggesting that no further comparisons are needed.

Evaluating veterinary practitioner perceptions of communication skills and training.

A survey was conducted among veterinary practitioners in the UK and the USA in 2012/2013. Thematic analysis was used to identify underlying reasons behind answers to questions about the importance of communication skills and the desire to participate in postgraduate communication skills training. Lack of training among more experienced veterinary surgeons, incomplete preparation of younger practitioners and differences in ability to communicate all contribute to gaps in communication competency. Barriers to participating in further communication training include time, cost and doubts in the ability of training to provide value. To help enhance communication ability, communication skills should be assessed in veterinary school applicants, and communication skills training should be more thoroughly integrated into veterinary curricula. Continuing education/professional development in communication should be part of all postgraduate education and should be targeted to learning style preferences and communication needs and challenges through an entire career in practice.

Comparison of a chlorhexidine and a benzoyl peroxide shampoo as sole treatment in canine superficial pyoderma.

The clinical and antibacterial efficacy of two shampoos used as a sole antibacterial treatment in dogs with superficial pyoderma were investigated and compared. In a randomised, partially blinded study, a 3 per cent chlorhexidine gluconate shampoo (Chlorhex 3; Leo Animal Health) was compared against a 2.5 per cent benzoyl peroxide shampoo (Paxcutol; Virbac) in 22 dogs with superficial pyoderma. Dogs were washed two to three times weekly with a 10-minute contact time over 21 days. Clinical scores and bacterial counts were assessed on days 1, 8 and 22 and compared within and between treatment groups; overall response was assessed at the end of the study. Twenty dogs completed the study; 15 (68.2 per cent) showed an overall clinical improvement and the clinical signs resolved in three chlorhexidine-treated dogs. In the chlorhexidine-treated group, scores for papules/pustules (P<0.001), investigator-assessed pruritus (P=0.003), total bacterial counts (P=0.003) and counts for coagulase-positive staphylococci (P=0.003) were reduced after three weeks. Scores and bacterial counts did not vary significantly in the benzoyl peroxide-treated group.

Topical fusidic acid/betamethasone-containing gel compared to systemic therapy in the treatment of canine acute moist dermatitis.

The efficacy of a topical preparation containing 0.5% fusidic acid and 0.1% betamethasone-17-valerate was compared to a systemic therapy (comprising a combination of parenteral dexamethasone and oral clavulanate-potentiated amoxycillin) in the treatment of 104 dogs with acute moist dermatitis. Significant improvement was evident after seven days in both treatment groups in all clinical parameters assessed and there was no significant difference in the overall response between the two treatment groups. Staphylococcus intermedius was the most frequently isolated organism from swabs at the first visit (Day 0). No resistance to fusidic acid or clavulanate-potentiated amoxycillin was encountered. The study demonstrates no difference in the clinical improvement achieved in canine acute moist dermatitis following topical or systemic therapy and that both treatment regimes represent effective treatment options for the condition.

Observations on the development of congestive heart failure in Irish wolfhounds with dilated cardiomyopathy.

Records of previous electrocardiographic (ECG) and echocardiographic examinations of 39 Irish wolfhounds with cardiac failure, obtained during a 10-year survey, were examined to establish whether previously detected abnormalities might be prognostic indicators for the development of congestive heart failure (CHF) due to dilated cardiomyopathy (DCM) in later life. Eighteen dogs (46 per cent) had had atrial fibrillation (AF) at their first examination. Other ECG abnormalities detected at previous examinations were ventricular and supraventricular premature contractions, first and second degree atrioventricular block, P mitrale and left anterior fascicular and right bundle branch blocks. All 39 dogs had developed AF by the time of onset of CHF. The mean age at which CHF was diagnosed was 77 months in males and 86 months in females. The mean age at which AF was first detected was 45 months in males and 59 months in females, and the mean time from the first detection of AF to CHF was 27 months in males and 24 months in females. Previous echocardiographic examinations in eight dogs, over a period of up to five years, revealed progressive left atrial and left ventricular dilatation. Fractional shortening was reduced to below the normal range at the onset of CHF compared with previous examinations in three cases but increased in five. It appears, therefore, that certain ECG abnormalities, especially AF, and/or progressive ventricular and atrial dilatation, may be indicators of 'occult' DCM in wolfhounds.

Porcine small intestinal submucosa as a dural substitute.

BACKGROUND: The continuing search for the ideal dural substitute is currently directed toward collagen preparations. Xenogeneic porcine small intestinal submucosa (SIS), a naturally occurring extracellular matrix rich in collagen, has been successfully used as a soft tissue graft in several body organ systems, including preliminary studies as a dural substitute in the rat. METHODS: Eight dogs underwent temporoparietal craniotomy and dural resection with replacement by SIS. Five dogs had contralateral procedures without SIS grafting. Three dogs had contralateral SIS grafts placed 2 months after the initial procedure. Histologic assessment was obtained at 7, 30, 60, 90, and 120 days. Cerebrospinal fluid (CSF) cytological examination and routine serum chemistry preceded sacrifice. RESULTS: Histologic evaluation showed initial graft infiltration by mononuclear round cells, spindle-shaped cells within an eosinophilic staining extracellular matrix, and neovascularity. Complete resorption of the graft was evident by 60 days. This pattern is consistent with the previously described incorporation and remodeling of the SIS graft at other sites. CSF cytology and routine serum chemistry at the time of sacrifice were normal. Response to repeat grafting was identical to that of initial exposure. There was no clinical or histologic evidence of sensitization or graft rejection. No evidence of adverse effect on the underlying cerebral cortex was observed. CONCLUSIONS: Porcine small intestinal submucosa demonstrates a favorable biologic response as a dural substitute in the canine model. It is a promising biomaterial for dural replacement.

CNS role in women's health promotion and maintenance in a collaborative practice.

The clinical nurse specialist (CNS) has an instrumental role in health promotion and maintenance for women. In the obstetrical/gynecological private practice setting, working in collaboration with a physician and other healthcare providers, the CNS has the opportunity to exercise the subroles of clinician, educator, consultant, and researcher. The CNS, as primary caregiver, can be influential in meeting the guidelines of Healthy People 2000 and implementing the interventions suggested in the Guide to Clinical Preventative Services for women.

Skeletal muscle extra-aortic counterpulsation in dogs with dilated cardiomyopathy.

Skeletal muscle extra-aortic counterpulsation was performed in seven dogs with dilated cardiomyopathy. A left latissimus dorsi dynamic descending thoracic aortomyoplasty was used as the autologous counterpulsator. Pulse train stimulation in diastole was used to initiate contraction and fibre type transformation. Two of the dogs died within 48 hours of surgery. The device was successfully activated in the five remaining dogs, but in one individual it failed within 48 hours of activation. Serial echocardiographic examinations of dogs in which the device functioned successfully (n = 4) showed trends towards the decrease in the left ventricular systolic internal dimension, left ventricular diastolic internal dimension, E-point to septal separation and left atrial diameter in systole seven to 14 days following the procedure, although these changes failed to persist in the long-term. The results suggest that skeletal muscle for cardiac assistances such as extra-aortic muscle counterpulsation, might be a therapeutic option for dogs with cardiac failure due to dilated cardiomyopathy.

Percutaneous balloon pericardiotomy for the management of malignant pericardial effusion in two dogs.

Two dogs with signs of right-sided congestive cardiac failure, due to recurrent pericardial effusion secondary to the presence of intrapericardial neoplasia, were treated by percutaneous balloon pericardiotomy. The first patient was euthanased one month after the procedure while the second patient developed ascites as a result of obstruction of the caudal vena cava by the growing tumour and was euthanased 14 weeks after the procedure. In neither case was there a recurrence of a significant volume of the effusion. Percutaneous balloon pericardiotomy represents an effective means of relieving recurrent malignant pericardial effusion, without resorting to thoracotomy.

Histology after dural grafting with small intestinal submucosa.

BACKGROUND: The search for the ideal dural substitute continues, inasmuch as available materials have significant limitations. Xenogeneic porcine small intestinal submucosa (SIS) has been successfully used as a soft tissue graft in several body organ systems, and it was logical to evaluate its use as a dural replacement. METHODS: Twenty rats underwent bihemispheric craniectomy with dural resection. SIS onlay grafting on one side was performed. Histologic assessment was obtained at 7 and 28 days after dural grafting and included descriptive evaluation and quantitative scoring of graft-site thickness, vascularity, and cellular density. The total scores for the respective groups were compared using the Student's t test, significance being accepted for a p value < 0.05. RESULTS: Histologic evaluation showed graft infiltration by spindle-shaped mononuclear cells, deposition of connective tissue, and neovascularity. This pattern is consistent with the previously described incorporation and remodeling of the SIS graft at other sites. A significant difference between the histologic scores of the SIS graft site and control site was found at 7 days (3.4 +/- 0.8 versus 0.1 +/- 0.1) and at 28 days (4.6 +/- 1.1 versus 2.2 +/- 0.5). No evidence of adverse effect on the underlying cortex was observed. CONCLUSIONS: The results of this preliminary study utilizing porcine SIS as a dural substitute are promising and therefore justify further chronic studies.

A technique for the creation of long autogenous tissue arterial patches.

An endarterectomized segment of an occluded artery (e.g. superficial femoral artery), is an alternative autogenous material for patch angioplasty which preserves the continuity of the saphenous vein. A technique of incising endarterectomized segments of superficial femoral artery in a spiraled manner is presented which allows for the creation of long autogenous tissue patches. A spiral is drawn on the exterior of a harvested arterial segment which is either 1 cm, 7 mm or 5 mm in width. When incised along the spiral, the length of the resulting elliptical patch will be two, three, or four times, respectively, the length of the original artery segment. The authors have used the technique to close extended profundoplasty in three patients and for construction of a patched distal anastomosis in two patients undergoing prosthetic femoropopliteal bypass grafting. There have been no early complications.

Significance of proliferating cell nuclear antigen in predicting recurrence of intracranial meningioma.

It is well known that the histological appearance of meningiomas often fails to predict accurately the clinical behavior of the tumor. Therefore, attention has turned from tumor histology to tumor biology. Proliferating cell nuclear antigen (PCNA), a cell cycle-regulated protein, has been recently characterized as the cofactor of DNA polymerase-delta, an enzyme required for DNA replication. The rate of synthesis of PCNA directly correlates with the proliferative state of cells. Immunohistochemical labeling of this antigen is now possible with monoclonal antibodies that allow for its demonstration in routinely fixed, paraffin-embedded specimens. In this study, the PCNA labeling index (LI) was determined for 83 meningiomas, including tumors with both benign and malignant clinical courses and with benign, atypical, and malignant histologies, apparent after total or subtotal resections. No statistical difference was found between the LI on recurrence and that found at initial presentation. In addition, stepwise multivariate regression analysis failed to identify any combination of factors (age, gender, race, age of specimen, tumor histology, Simpson grade of resection) that contributes to the predictive strength of the PCNA LI for tumor recurrence. However, for LIs less than 2%, only one of 26 gross totally resected tumors recurred (mean follow up 53 months); for LIs more than 7%, five of 13 gross totally resected tumors recurred (mean follow up 55 months). The difference in recurrence rates between gross totally resected meningiomas with PCNA LIs less than 2% and those with PCNA LIs more than 7% achieved statistical significance with a Fisher's exact probability equaling 0.011. The authors conclude that quantitative PCNA labeling of meningiomas is a promising technique that can provide meaningful prognostic information.

Mitral valve replacement for the treatment of congenital mitral dysplasia in a bull terrier.

A 10-month-old entire male bull terrier was presented with a history of collapse on exercise. Clinical examination, electrocardiography, radiography and echocardiography all supported a diagnosis of mitral valve dysplasia. There was no evidence of congestive heart failure. Surgical intervention consisted of open resection of the dysplastic mitral valve and its replacement with a bioprosthetic valve. The procedure was performed through a median sternotomy and the dog was placed on to full cardiopulmonary bypass. Total cardiopulmonary bypass time was 70 minutes. A full recovery was made and at the time of writing (17 months postoperatively) the dog is clincally normal requiring no medication.

Ontogeny of the pectoralis muscle in the little brown bat, Myotis lucifugus.

The ontogeny of a primary flight muscle, the pectoralis, in the little brown bat (Myotis lucifugus: Vespertilionidae) was studied using histochemical, immunocytochemical, and electrophoretic techniques. In fetal and early neonatal (postnatal age 1-6 days) Myotis, histochemical techniques for myofibrillar ATPase (mATPase) and antibodies for slow and fast myosins demonstrated the presence of two fiber types, here called types I and IIa. These data correlated with multiple transitional myosin heavy chain isoforms and native myosin isoforms demonstrated with SDS-PAGE and 4% pyrophosphate PAGE. There was a decrease in the distribution and number of type I fibers with increasing postnatal age. At postnatal age 8-9 days, the adult phenotype was observed with regard to muscle fiber type (100% type IIa fibers) and myosin isoform profile (single adult MHC and native myosin isoforms). This "adult" fiber type profile and myosin isoform composition preceded adult function by about 2 weeks. For example, little brown bats were incapable of sustained flight until approximately postnatal day 24, and myofiber size did not achieve adult size until approximately postnatal day 25. Although Myotis pectoralis is unique in being composed of 100% type IIa fibers, transitional fiber types and isoforms were present. These transitional forms had been observed previously in other mammals bearing mixed adult muscle fibers and which undergo transitional stages in muscle ontogeny. However, in Myotis pectoralis, this transition transpires relatively early in development.

Use of indirect immunofluorescence and western blotting to assess the role of circulating antimyocardial antibodies in dogs with dilated cardiomyopathy.

The presence of circulating anti-heart IgG and IgM autoantibodies was assessed by indirect immunofluorescence and by probing Western blot transfers of normal canine myocardial proteins separated by sodium dodecyl sulphate polyacrylamide gel electrophoresis with samples of sera from dogs with dilated cardiomyopathy (n = 27) and from healthy control dogs (n = 20). No difference was demonstrated between the two groups using either method. Sera taken from the affected dogs at three monthly intervals throughout the course of the disease showed no change at all in the pattern of reactivity. The results of this study suggest that indirect immunofluorescence and the probing of Western blot transfers of a crude preparation of normal canine myocardium with canine sera will demonstrate too many apparent autoantigens for the technique to identify unique, disease-associated autoantibodies.

Neonatal development of the diaphragm of the horse, Equus caballus.

The diaphragm of neonatal horses is significantly different from the diaphragm of adult horses in terms of histochemical fiber type composition, myosin heavy chain isoform, and native myosin isoform composition. There is a significant increase in the percentage of type I fibers present in the diaphragm with increasing age from birth through about seven months postnatal age. A possible lack of postural tone in the hiatal region of the neonatal diaphragm is suggested to account for increased incidence of vomiting or aspiration pneumonia in younger horses. The isoform data lead to rejection of the hypothesis that the diaphragm of the horse should, as an ungulate, be relatively precocial in its rate of maturation relative to other non-ungulate mammals that have been studied.