Post-mortem ultrasonographic and computed tomographic features of the anatomical variations and acquired pathological bony changes of the lumbosacroiliac region in a mixed population of horses.

BACKGROUND: Transrectal ultrasonography is the best technique for evaluating the ventral aspect of the lumbosacral and sacroiliac regions yet this diagnostic technique does not always lead to a final diagnosis of back pain in horses. OBJECTIVES: To describe anatomical variations and acquired pathological bony changes (APBCs) in the lumbosacral and sacroiliac regions detected by ultrasonography (US) and computed tomography (CT) examinations on specimens. We hypothesised that age, body mass, previous use and anatomical variations may be correlated with the presence and/or severity of APBCs. STUDY DESIGN: Descriptive cadaver study. METHODS: Lumbosacroiliac specimens were obtained from 51 horses that died or were euthanised for reasons other than the study and underwent US and CT examinations post-mortem. RESULTS: Forty-two specimens were analysed. The most prevalent lumbosacral disc morphology was type 2 (21/42), and protrusions were found in 15/42 specimens. Abnormal echogenicity of the L5-L6 and lumbosacral discs was detected in 11/42 and 30/42 specimens, respectively. Abnormalities in the size of the L5-L6 disc were found in 10/42 specimens and correlated with promontorium localisation (Cramér's V coefficient [V] = 0.42) and lumbosacral disc morphology (type 1: V = 0.41; type 5: V = 0.69). The most prevalent orientation of the L6 spinous process (SP) was convergent (24/42). The promontoria were mostly located between L6 and S1 (36/42). Lumbosacral spondylosis was detected in 24/42 specimens and spondylolisthesis in one. Age was associated with the severity of APBCs in the sacroiliac joints, lumbosacral intertransverse joints, articular process joints, spondylosis and L6 or S1 bone plate irregularities. Lumbosacral spondylosis or L6 extremitas caudalis irregularity was associated with lumbosacral angulation, variability in the size of the L5-L6 disc and localisation of the promontorium, L6 SP orientation and L6 extremitas caudalis irregularity with abnormal echogenicity of the LS disc. MAIN LIMITATIONS: Lack of information on clinical signs. CONCLUSIONS: High variability and prevalence of the anatomical variations and APBCs in the lumbosacroiliac region were observed, and correlations between some anatomical variations and APBCs and between APBCs and age were reported.

Post-Mortem Computed Tomographic Features of the Most Caudal Lumbar Vertebrae, Anatomical Variations and Acquired Osseous Pathological Changes, in a Mixed Population of Horses.

The radiographic, ultrasonographic, and scintigraphic findings of horses with thoracolumbosacral pain have been previously reported. In this study, the computed tomographic appearance of anatomical variations and pathological changes of the equine caudal lumbar region through a post-mortem examination were investigated. A total of 40 horses that had died or were submitted for euthanasia, for reasons unrelated to the study, were included in the study. From all the specimens, the modified vertebral system was adopted to evaluate and describe the four most caudal lumbar vertebrae, which were numbered from a caudal reference point (lumbosacral junction), with the segment number designated within parentheses (i.e., L(i)-L(iv)). Contact of the spinous processes was detected in 21 specimens (54%) and fusion in 6 specimens (15%). Lumbar spondylosis was seen in 17 specimens (42.5%), more commonly on the lateral aspect or on both ventral and lateral aspects in 12 specimens (71%). The presence of spondylosis was found more commonly in older horses (p < 0.001). There was no difference in bony density in specimens with spondylosis or spinous processes contact compared to specimens without. The highest prevalence of bony changes was found at L(ii)-L(i) intertransverse joints in 28 specimens (97%) on the left and in 22 specimens (96%) on the right side. Spondylolisthesis and partial fusion of the L(ii)-L(i) vertebral disc were found in association with degenerative pathologies. This study showed a high frequency of several anatomical variations and acquired osseous pathological changes in the most caudal lumbar vertebrae via a CT examination.

Intracardiac Porcupine Quill Migration in a Dog: Multimodality Imaging Findings and Surgical Management.

The porcupine is a nocturnal quill-bearing rodent common throughout Italy. When threatened, it defends itself by erecting its quills, rattling its tail, and running sideways or backyard into predators. The quills are released upon contact with assailants and tend to migrate into several body tissues or cavities due to the unique inverted cuticles (crenate) directed downwards to the quill base (a sort of "harpoon effect"). Intracardiac migration of porcupine quills has been reported in a few dogs with severe clinical signs. This case report describes a single porcupine quill [Hystrix cristata, (HC)] migration through the heart in a dog and the use of multimodality imaging for the diagnosis and surgical approach. A 4-year-old 25 kg female mixed-breed dog was presented for evaluation of recurrent fever. Transthoracic echocardiographic examination showed a linear, hyperechoic foreign body traversing the interventricular septum from the heart base to the cardiac apex. Computed tomography and transesophageal echocardiography confirmed the presence of a single structure resembling a quill; a later esophageal endoscopy showed no anatomical alterations or mucosal injuries. Following median sternotomy and after accurate localization by intraoperative ultrasound, the quill was successfully removed. The dog had a good recovery without evidence of severe cardiac injury secondary to an intracardiac quill. To the best of the authors' knowledge, the identification of an intracardiac HC quill by ultrasonography and CT and its successful removal by ultrasound guide has not been previously reported.

A Pleistocene Fight Club revealed by the palaeobiological study of the Dama-like deer record from Pantalla (Italy).

Here, we report on the exceptionally well-preserved deer record from the locality of Pantalla (central Italy), dated in the Early Pleistocene (ca. 2.1-2.0 million years ago). The fossils show a combination of characters that allows an unambiguous attribution to 'Pseudodama' nestii, of which they represent one of the most informative collections to date. Our comparisons-also conducted through CT-based methods on endocranial structures-reveal that the cranial and postcranial skeleton of 'P.' nestii displays a mosaic of intermediate characters between extant Dama and Cervus, but also that the affinities with Dama are prevalent. Some Cervus-like features especially in cranial morphology, can be interpreted as plesiomorphic characters supporting a basal position of 'Pseudodama' among the Cervini. Interestingly, three bone anomalies are described in the two male crania of 'P.' nestii from Pantalla and are interpreted as palaeotraumatological evidence resulting from different injuries suffered by the deer during their life. This allows opening a treasure trove of information on paleobiological aspects, including ontogeny and antler cycle and function.

Multimodal Diagnostic Imaging to Identify Septic Apophysitis of the Proximal Humerus in a Thoroughbred Foal.

A 4-month-old Thoroughbred filly was referred for evaluation of severe left forelimb lameness of 24 hours duration. Radiographic projections of the shoulder revealed mild irregularity and sclerosis of the proximal humeral apophysis. Ultrasonographic examination showed a moderate increase in the amount of anechogenic synovial fluid within the intertubercular bursa and scapulohumeral joint, and irregularity of the ossifying bone surface of the intermediate tubercle of the humerus. Computed tomographic (CT) examination revealed a circular hypoattenuating area at the level of the proximal apophysis of the humerus. CT imaging in this case was essential for an early identification of the septic foci and it allowed ultrasound-guided sample from the lesion for the selection of targeted antibiotic therapy.

Double-Outlet Right Ventricle in a Chianina Calf.

Congenital heart defects have been occasionally reported in cattle and ventricular septal defect represents the most frequently encountered anomaly. The double-outlet right ventricle is a rare congenital ventriculoarterial malformation reported only in certain cattle breeds. We describe this rare and complex congenital cardiac malformation observed in a 10-day-old male Chianina calf. Clinical examination showed tachycardia, tachypnea, jugular pulses, cyanotic mucous membranes and a right apical systolic murmur. Transthoracic echocardiography revealed severe dilation of the right-sided cardiac chambers with a markedly hypoplastic left ventricle. Both aorta and pulmonary artery leaving the right ventricle in parallel alignment with the tricuspid valve were suggestive of a dual-outlet right ventricle. Interventricular and interatrial septal defects were also visualized. Post-mortem examination confirmed the echocardiographic findings. To the authors' knowledge, a similar complex congenital cardiac malformation has not been reported in calves of the Chianina breed to date.

Prostatic Localization of a Migrating Grass Awn Foreign Body in a Dog.

A 13-year-old male mixed-breed dog was examined because of hematuria and pyrexia. Ultrasonographic examination of the genitourinary tract showed the presence of a migrating grass awn in the right prostatic lobe. Laparotomy allowed, under ultrasonographic guidance, to remove entirely the migrating grass awn from the prostatic parenchyma. The recovery was uneventful and four months after the surgery the owner reported that the dog showed the complete resolution of the clinical signs and full return to normal activity. To our knowledge, this case report describes for the first time the clinical presentation, imaging findings, management and outcome for a dog with prostatic localization of a migrating grass awn.

Functional endoscopic sinus surgery in a cat with nasal tumor.

An 11-year-old, 5.8-kg, male European cat was presented with a 4-month history of sneezing, nasal discharge, respiratory distress and bilateral conjunctivitis. Physical examination showed bilateral hemorrhagic mucopurulent nasal discharge and stertorous respiratory sounds. An irregular shaped mass involving the aboral portion of the right nasal cavity and sphenoidal sinus was identified by computed tomography. The mass was localized endoscopically in the medium meatus and an endoscopic-guided biopsy was performed. B-cell lymphoma was diagnosed by histopathological and immunochemistry exams. Functional endoscopic sinus surgery allowed to completely remove the tumor and restore a normal nasal flow. The cat showed no recurrence of the neoplasia for 15 months after the functional endoscopic sinus surgery.

Contrast-enhanced ultrasonographic findings in three dogs with lung lobe torsion.

Lung lobe torsion is rare but life-threatening condition in the dog. Thoracic radiographs and conventional ultrasonography cannot be conclusive for the diagnosis, and computed tomography is useful but is limited by cost and availability. This report describes the findings of contrast-enhanced ultrasonography in 3 dogs with lung lobe torsion. Contrast-enhanced ultrasonography showed the absence or reduction of pulmonary vascularization secondary to twisting of the lung lobe around its bronchovascular pedicle in all three dogs. Moreover, contrast-enhanced ultrasonography distinguished partial pulmonary atelectasis from a lung lobe torsion. These preliminary results suggest that contrast-enhanced ultrasonography can improve the accuracy of conventional ultrasonography for detection of pulmonary blood flow compromise in dogs with lung lobe torsion.

IMAGING DIAGNOSIS - USE OF MULTIPHASE COMPUTED TOMOGRAPHIC UROGRAPHY IN THE DIAGNOSIS OF URETERAL TEAR IN A 6-DAY-OLD FOAL.

A 6-day-old foal was evaluated for depression and inappetence. After initial stabilization, the filly developed a hypochloremic metabolic alkalosis and persistent hypercreatinemia. Abdominal ultrasound revealed fluid accumulation around the left kidney and a well-defined rounded fluid filled structure dorsal to the urinary bladder. Computed tomography revealed a partial tear of the left ureter with distension of the retroperitoneal membrane. Exploratory celiotomy was performed to allow left kidney nephrectomy. At 6 months follow-up, the filly was growing normally without complications. Ultrasound and CT imaging in this case provided an accurate diagnosis and a presurgical aid to select the appropriate therapeutic approach.

Alfaxalone anesthesia by immersion in oriental fire-bellied toads (Bombina orientalis).

OBJECTIVES: To establish an effective alfaxalone concentration to be used for bath immersion of fire-bellied toads (Bombina orientalis) and to describe its effects. STUDY DESIGN: Prospective experimental study. ANIMALS: Thirteen oriental fire-bellied toads. METHODS: The study was carried out in two phases. The pilot phase involved five animals and aimed to identify an alfaxalone concentration capable of producing induction of anesthesia, defined as immobility with a head down position and loss of responsiveness to stimulation with a stick. The following trial in an additional eight toads used the effective alfaxalone concentration established during the pilot phase. Data from 11 animals (three toads in the pilot study and the eight additional toads) were analyzed. Twenty minutes after immersion in the anesthetic solution, the toads were removed from the bath, and heart rate, respiratory rate, the righting, myotactic and the nociceptive withdrawal reflexes were evaluated every 5 minutes. The loss of both righting and nociceptive withdrawal reflexes was considered indicative of a surgical depth of anesthesia. The time elapsed from anesthetic induction to return of righting reflex, the quality of recovery and the occurrence of undesired effects were observed and recorded. RESULTS: Immersion was found to be a suitable anesthetic technique for oriental fire-bellied toads and 200 mg L(-1) alfaxalone concentration produced anesthetic induction in 10 out of 11 toads. Side effects, such as skin irritation, erythema and changes in cutaneous pigmentation, were not observed in any animal. The duration of anesthesia ranged from 10 to 30 minutes after removal of the toads from the alfaxalone bath, and surgical depth of anesthesia was never achieved. CONCLUSIONS AND CLINICAL RELEVANCE: It was concluded that alfaxalone anesthesia induced by immersion in a concentration of 200 mg L(-1) is only suitable for toads undergoing non-invasive short procedures.

Imaging diagnosis--transesophageal ultrasound-guided removal of a migrating grass awn foreign body in a dog.

A 3-year-old English Setter dog was presented for an acute onset of coughing. Tracheobronchoscopic examination allowed localization and removal of one grass awn foreign body. A second migrated grass awn was suspected to be present in the left caudal lung lobe. Transesophageal ultrasound revealed an area of pulmonary consolidation in the dorsomedial portion of left caudal lobe and a linear hyperechoic structure consistent with a grass awn foreign body within the area of consolidation. Transesophageal ultrasonography was also used to provide anatomical landmarks that facilitated successful thoracoscopic removal of the foreign body.

Ultrasound-guided pudendal nerve block in cats undergoing perineal urethrostomy: a prospective, randomised, investigator-blind, placebo-controlled clinical trial.

The objective of this study was to evaluate the clinical usefulness, in terms of analgesic efficacy and safety, of ultrasound-guided pudendal nerve block performed with bupivacaine in cats undergoing perineal urethrostomy. Eighteen client-owned male cats scheduled for perineal urethrostomy were enrolled in the study and assigned to one of two treatment groups. The pudendal nerve block was performed under general anaesthesia, as described elsewhere, with 0.3 ml/kg of either saline (group C) or 0.5% bupivacaine (group B) - the total injection volume being split equally between the two sites of injection (left and right). Intra-operatively, assessment of nociception was based on the rescue analgesics requirement, as well as on the evaluation of changes in physiological parameters in comparison with the baseline values. Postoperative pain assessment was performed using three different pain scales at recovery and then 1, 2 and 3 h after recovery. Cats in group B showed lower heart rates and required fewer analgesics during surgery than group C. Postoperatively, group B had lower pain scores and needed less rescue buprenorphine than group C. Iatrogenic block-related complications were not observed. In conclusion, the ultrasound-guided pudendal nerve block can be considered clinically useful in feline medicine as it provides reliable analgesia in cats undergoing perineal urethrostomy.

Development of an ultrasound-guided technique for pudendal nerve block in cat cadavers.

The objective of this prospective experimental cadaveric study was to develop an ultrasound-guided technique to perform an anaesthetic pudendal nerve block in male cats. Fifteen fresh cadavers were used for this trial. A detailed anatomical dissection was performed on one cat in order to scrutinise the pudendal nerve and its ramifications. In a second step, the cadavers of six cats were used to test three different ultrasonographic approaches to the pudendal nerve: the deep dorso-lateral, the superficial dorso-lateral and the median transperineal. Although none of the approaches allowed direct ultrasonographical identification of the pudendal nerve branches, the deep dorso-lateral was found to be the most advantageous one in terms of practicability and ability to identify useful and reliable landmarks. Based on these findings, the deep dorso-lateral approach was selected as technique of choice for tracer injections (0.1 ml 1% methylene blue injected bilaterally) in six cat cadavers distinct from those used for the ultrasonographical study. Anatomical dissection revealed a homogeneous spread of the tracer around the pudendal nerve sensory branches in all six cadavers. Finally, computed tomography was performed in two additional cadavers after injection of 0.3 ml/kg (0.15 ml/kg per each injection sites, left and right) contrast medium through the deep dorso-lateral approach in order to obtain a model of volume distribution applicable to local anaesthetics. Our findings in cat cadavers indicate that ultrasound-guided pudendal nerve block is feasible and could be proposed to provide peri-operative analgesia in clinical patients undergoing perineal urethrostomy.

Reversal of experimental Laron Syndrome by xenotransplantation of microencapsulated porcine Sertoli cells.

Recombinant human IGF-1 currently represents the only available treatment option for the Laron Syndrome, a rare human disorder caused by defects in the gene encoding growth hormone receptor, resulting in irreversibly retarded growth. Unfortunately, this treatment therapy, poorly impacts longitudinal growth (13% in females and 19% in males), while burdening the patients with severe side effects, including hypoglycemia, in association with the unfair chore of taking multiple daily injections that cause local intense pain. In this study, we have demonstrated that a single intraperitoneal graft of microencapsulated pig Sertoli cells, producing pig insulin-like growth factor-1, successfully promoted significant proportional growth in the Laron mouse, a unique animal model of the human Laron Syndrome. These findings indicate a novel, simply, safe and successful method for the cell therapy-based cure of the Laron Syndrome, potentially applicable to humans.

Perifosine as a potential novel anti-cancer agent inhibits EGFR/MET-AKT axis in malignant pleural mesothelioma.

BACKGROUND: PI3K/AKT signalling pathway is aberrantly active and plays a critical role for cell cycle progression of human malignant pleural mesothelioma (MMe) cells. AKT is one of the important cellular targets of perifosine, a novel bio-available alkylphospholipid that has displayed significant anti-proliferative activity in vitro and in vivo in several human tumour model systems and is currently being tested in clinical trials. METHODS: We tested Perifosine activity on human mesothelial cells and different mesothelioma cell lines, in order to provide evidence of its efficacy as single agent and combined therapy. RESULTS: We demonstrate here that perifosine, currently being evaluated as an anti-cancer agent in phase 1 and 2 clinical trials, caused a dose-dependent reduction of AKT activation, at concentrations causing MMe cell growth arrest. In this study we firstly describe that MMe cells express aside from AKT1 also AKT3 and that either the myristoylated, constitutively active, forms of the two proteins, abrogated perifosine-mediated cell growth inhibition. Moreover, we describe here a novel mechanism of perifosine that interferes, upstream of AKT, affecting EGFR and MET phosphorylation. Finally, we demonstrate a significant increase in cell toxicity when MMe cells were treated with perifosine in combination with cisplatin. CONCLUSIONS: This study provides a novel mechanism of action of perifosine, directly inhibiting EGFR/MET-AKT1/3 axis, providing a rationale for a novel translational approach to the treatment of MMe.

Behavior of aqueous nanocrystalline hydroxyapatite in oral bone regeneration.

PURPOSE: A skeletal segment consisting exclusively of bone is the target outcome of bone regeneration. Granular hydroxyapatites form a hydroxyapatite-bone composite, unsuitable for effectively supporting implants, which may persist for many years. This work aimed to investigate the reasons for the bone replacement of Ostim®, a recently commercialized aqueous nanocrystalline hydroxyapatite. METHODS: Histology, SEM and X-ray microanalysis were employed to analyze 6- to 9-month biopsies of post-extractive sites or sinus floor lifts of the maxilla in 15 subjects. RESULTS: The results highlight a great bone formation, Ostim® resorption with time by osteoclasts but also interstitial fluid propagation of Ostim® masses by percolation. A possible osteocyte protoplasmic involvement was also at work in concert to reach the target. CONCLUSIONS: The use of Ostim® as bone regenerating material leads to the formation of a highly suitable implant support consisting exclusively of bone in less than 12 months, i.e. in a remarkably short time.

Cutaneous metaplastic synovial cyst in Ehlers-Danlos syndrome: report of a second case.

A cutaneous metaplastic synovial cyst is a rare entity that is probably caused by trauma or surgery. We report the second case of cutaneous metaplastic synovial cyst in a child with Ehlers-Danlos syndrome. His father is also affected with Ehlers-Danlos syndrome, and his diagnosis is substantiated by the demonstration of reduced synthesis of collagen type V.

Identification and characterization of human papillomavirus DNA sequences in Italian breast cancer patients by PCR and line probe assay reverse hybridization.

Human papillomavirus (HPV) infection is known to play a fundamental role in cervical and other ano-genital human cancers. The recent identification of HPVs in human breast tumors and the immortalization of normal breast cancer cells by HPV high risk types 16 and 18 suggest that the virus could be implicated in the pathogenesis of human mammary tumors. In this study, we investigated the presence of high and low risk HPV genotypes in 30 human breast cancers of different histotypes by PCR with specific HPV primers (MY09/MY11 and GP5+/GP6+) and by line probe assay (LiPA) reverse hybridization. Since the only positive case (untypable HPVX+) was a papillary breast carcinoma, a rare tumor variant, we analyzed a further cohort of 32 papillary cancers and found one additional HPV DNA-positive case (HPV66+). Our results suggest that HPV infection is not significant in mammary tumorigenesis, with the exception of particular tumor histotypes, such as papillary cancer.

Two cases of secondary soft tissue sarcomas after radiotherapy and radiochemotherapy.

BACKGROUND: The development of secondary soft tissue sarcomas after chemo-radiotherapy is a rare and little known event, but its frequency is increasing. PATIENTS AND METHODS: We report two cases of secondary soft tissue sarcomas. The first is the case of a 51-year-old woman treated for Hodgkin's disease with chemotherapy and radiotherapy 15 years before she developed a high-grade malignant pleural sarcoma. The patient had no history of asbestos exposure. The second is the case of a 64-year-old woman with a giant cell malignant histiocytoma secondary to colorectal cancer treated with surgery and radiotherapy nine years before. The patients were not eligible for surgery or radiotherapy. Both were treated with chemotherapy (ifosfamide and epirubicin) without any relevant secondary effects; however, the response to therapy was poor. CONCLUSIONS: The causes of secondary malignancies are multifactorial, but radiation therapy and chemotherapy are certainly implicated in the development of post-therapy neoplasms that are difficult to treat.