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.

The use of the HiSPECT bone scan in canine flexor enthesopathy and coronoid pathology.

In this study the use of the high resolution Micro-Single Photon Emission Tomography (HiSPECT) system with a radioactive bonemarker, (99m)Tc-oxidronate, was evaluated in dogs with coronoid pathology and/or flexor enthesopathy. Sixty-five elbows of 34 dogs were included. CT and HiSPECT were performed on all elbows, arthroscopy on 59. Tracer uptake in 8 anatomical regions was graded according to two models. Increased activity in the medial epicondylar region was associated with flexor pathology on CT (P=0.0002) and arthroscopy (P<0.0001) and increased uptake in the medial coronoid (P<0.0001) and the medial condylar area (P<0.013) with coronoid pathology. Uptake in the remaining areas was not associated with both pathologies. In conclusion, the improved resolution of the HiSPECT system allows identification of increased tracer uptake in the anatomical regions involved in coronoid pathology and flexor enthesopathy. This modality may improve the diagnostic potential of the bone scan in canine elbow disease.

Recognition of anatomical predilection sites in canine elbow pathology on bone scans using micro-single photon emission tomography.

The limited resolution of planar bone scintigraphy precludes exact anatomical localisation within a joint. Micro-single photon emission tomography (µ-SPECT) has a much higher resolution, and in this study the use of µ-SPECT in the evaluation of the canine elbow joint and fusion with structural imaging data were tested. Twelve elbows of seven normal dogs were included. µ-SPECT was performed with a conventional triple head gamma camera adapted with three multi-pinhole collimators (HiSPECT). Radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) were performed on all elbows and data from CT and MRI were fused to the HiSPECT data using dedicated software. Different important anatomical regions could be recognised on the HiSPECT images. The improved resolution of the HiSPECT system allowed better differentiation of the anatomical areas in the elbow joint. Two case studies were included to demonstrate the potential of this methodology. Fusion software facilitated the use of combined structural and functional information.

Risk factors of anaemia among rural school children in Kenitra, Morocco.

OBJECTIVE: To determine the prevalence of anaemia and factors associated with iron deficiency among school children in rural Kenitra, Morocco. METHODS: 295 students between 6 and 16 years old composed the study group. The level of haemoglobin was measured in a group of 295 school children. The iron status was determined by ferritin level in serum, and anaemia was defined when haemoglobin <11.5 g/dl. Iron deficiency was defined as ferritin level <15 microg/l. A questionnaire was developed to obtain information on the socio-economic and demographic status of the family such as the size of household, the income and possessions as well as educational status of the parents. RESULTS: The mean haemoglobin concentration was 12.4 g/dl in boys and 12.5 g/dl in girls, whereas the mean ferritin level was 26.7 microg/l in boys and 27.9 microg/l in girls. The overall prevalence of anaemia in the studied population was 12.2% and iron deficiency was 20.4%. There was a significant relationship between education of the mother and anaemia in children (p= 0.01). Serum ferritin (SF), serum iron concentrations and mean corpuscular volume (MCV) were significantly correlated with haemoglobin by multiple regression analysis. However, using logistic regression analysis, the results showed that anaemia was not significantly associated with gender, parents' employment and monthly family income. CONCLUSION: Anaemia remains a common problem in the young children particularly the primary education school boys of the households of low income. The results suggest also, that iron deficiency is an important determinant of anaemia in this population; however, whole anaemia cannot be solely explained by iron deficiency. Further studies are needed to consider micronutrients status and exposure to environmental pollutants.

[Unilateral facial paralysis and keratitis sicca, signs of temporohyoid osteoarthropathy in the horse]. / Eenzijdige facialis-paralyse en keratitis sicca bij een paard met temporohyoïd-osteoartropathie.

A 9-year-old Dutch Warmblood mare was presented with a history of abnormal behaviour and acute facial nerve paralysis on the left side. Clinical examination revealed a slight head tilt and a corneal ulcer of the left eye. The base of the left ear was warm and painful. Endoscopic examination of the left guttural pouch showed thickening of the proximal part of the stylohyoid bone. Computer tomography revealed a left-sided prominent bony enlargement of the middle and proximal part of the stylohyoid bone and the tympanic bulla, fusion of the temporrhoid joint, and osseous proliferation of the pars petrosa of the temporal bone. The diagnosis was confirmed postmortem. The literature concerning the anatomy, clinical signs, and therapy of temporrhoid osteoarthropathy is discussed.

[Ataxia and pruritus in a pony due to a cervical vertebral fracture]. / Ataxie en pruritus bij een pony als gevolg van een halswervelfractuur.

A mini-Shetland stallion was referred with bilateral pruritus localized to the anterior neck. More detailed clinical examination also revealed ataxia, and diagnostic imaging, including pre- and post-contrast computed tomography, revealed an old fracture of C2. Spinal cord compression was diagnosed. The probable causal relation between the fracture, the ataxia, and the localized pruritus seems comparable to the 'contusio cervicalis posterior' in humans, in which spinal cord trauma may cause pruritus in the associated dermatome.

Relationships of age and shape of the navicular bone to the development of navicular disease: a radiological study.

Estimating the shape of the proximal articular border of the navicular bone and grading the radiological navicular bone condition (grades 3 and 4 representing the most severe changes), the aim of this study was to assess potential age-related implications of the previously reported shape predisposition to navicular disease in 746 normal and 174 clinically affected Dutch Warmbloods age 3-19 years. A significant, age-independent, shape-grade association found in normal and affected horses emphasises the fundamental character of the shape predisposition to navicular disease. A significant age-related increase of the least susceptible shape prevalence was found in elderly normal horses. A shape-independent low grades 3 and 4 prevalence (mean 15%) was found in normal horses, vs. a high grades 3 and 4 prevalence (mean 85%) in the affected horses. Therefore, the clinical manifestation of the disease is grade-rather than shape-dependent. A significant age-related appearance of inverted flask-shaped channels and enthesophytes was found in the clinically affected horses. However, considering the significant shape-radiological features association previously reported in 3-year-old normal horses, this association may be shape- rather than age-dependent.

The radiographic development of the distal and proximal double contours of the equine navicular bone on dorsoproximal-palmarodistal oblique (upright pedal) radiographs, from age 1 to 11 months.

The aim of this study was to monitor the postnatal radiographic development of the proximal and distal double contours and the modelling of the shape of the proximal articular border. In mature horses, the proximal and distal contours of the navicular bone on dorsopalmar dorsoproximal-palmarodistal oblique (upright pedal) radiographs are commonly visualised as 2 lines, one being the articular border and the second representing the border of the cortex facing the deep digital flexor tendon (flexor border). The shape of the proximal articular border may be concave, undulating, straight or convex in the mature animal. These shapes have been found to be hereditary and to constitute a predisposing factor in the pathogenesis of navicular disease. This predisposing role may result from a shape dependent distribution of the biomechanical forces exerted on this region. There is no agreement in the literature with respect to the moment when the navicular bone takes its mature radiographic appearance. Upright pedal radiographs of the left front foot of 19 Dutch Warmblood foals were made at age 1 month and subsequently at intervals of 4 weeks, until the age of 11 months. The distal double contour developed soon after birth and the radiographic visibility of the articular border improved from ill-defined at 1 or 2 months to clear manifestation at 3 or 4 months. The proximal double contour developed later. The articular border became usually visible at age 3 or 4 months and was clearly visible from age 9 months. The mature shape of the proximal articular border usually became recognisable from age 7 months and was always obvious between 9 and 11 months. This development was associated with a gradual modelling of the lateral and medial extremities of the navicular bone. It was concluded that the navicular bone adopts its mature radiological appearance during the first year postpartum. Considering this early manifestation of the mature shape of the proximal articular border and its previously demonstrated inheritance, a force-dependent development of this shape, as predicted by the trajectional theory/Wolffs law, is improbable. The predisposing role of this shape in the pathogenesis of navicular disease may therefore be explained by a shape-dependent distribution of the biomechanical forces exerted on the navicular bone. Considering the potential application of these findings, from age 1 year shape determination enables identification of the individual and breed susceptibility for the development of navicular disease.

Radiographic development of osteochondral abnormalities, in the hock and stifle of Dutch Warmblood foals, from age 1 to 11 months.

In a longitudinal study the hocks and stifles of Dutch Warmblood foals were radiographed at age 1 month and subsequently at intervals of 4 weeks. Forty-three foals were radiographed until age 5 months and 19 foals until age 11 months. The chance for the development of osteochondrosis was enhanced by using only offspring from diseased sires with radiographically proven OC at either the intermediate ridge of the distal tibia or the lateral ridge of the femoral trochlea. The radiographic appearances of the intermediate ridge of the distal tibia, the distal aspect of the lateral trochlear ridge of the talus and the midregion of the lateral ridge of the femoral trochlea were classified on a 0-4 scale using a standardised radiographic classification. At age 1 month the appearance of the intermediate ridge of the distal tibia was frequently abnormal (grades 1-3: 67%; grade 4: 1%). Abnormal appearances of the distal aspect of the lateral trochlear ridge of the talus were less common (grades 1-3: 25%; grade 4: 6%). The midregion of the lateral ridge of the femoral trochlea was predominantly normal (grade 0: 98%; grade 1: 2%). Initial abnormalities of the intermediate tibial ridge showed a marked tendency for regression. Progression was less common. Normal appearances rarely turned into abnormal. Only 18% of the hocks were still abnormal at this site at age 11 months. Abnormalities of the distal aspect of the lateral trochlear ridge of the talus showed a strong tendency towards resolution. Progression never occurred. Normal appearances seldom turned into abnormal. Only 3% of the hocks were still abnormal at this site at age 11 months. For both predilection sites in the hock normal and abnormal appearances were permanent from age 5 months. In the stifle, abnormal appearances of the midregion of the lateral ridge of the femoral trochlea became obvious from age 3 or 4 months. Subsequent progression was usually followed by regression and resolution, the appearance returned in most cases to normal at age 8 months. At 5 months, 20% of the stifles were abnormal, but at 11 months this percentage had decreased to 3%. Normal and abnormal appearances were permanent from age 8 months. Osteochondrosis of the main predilection sites in the hock and stifle develops very early in life. The majority of the lesions were temporary, the 'age of no return' was 5 months for the hock and 8 months for the stifle.

Computed tomography of cholesterinic granulomas in the choroid plexus of horses.

Cholesterinic granulomas are tumor-like masses in the choroid plexuses of horses. This report describes the computed tomographic findings in four horses with cholesterinic granulomas, including the clinical and the pathologic features. All four horses had bilateral cholesterinic granulomas in the lateral ventricles. Computed tomographic images clearly delineated the masses, the opacity of the granulomas, and the enhancement pattern after intravenous bolus injection of contrast medium; these factors varied considerably. Additional CT findings were symmetric or asymmetric widening of the lateral ventricles.

Three cases of carcinoid in the equine nasal cavity and maxillary sinuses: histologic and immunohistochemical features.

Three cases of carcinoid tumor in horses are described. The tumors originated from the maxillary sinuses and the retrobulbar region and caused exophthalmos. Histologically, they had a characteristic endocrine pattern and were argyrophilic with the Grimelius stain. All tumors contained reactivity for neuron-specific enolase and synaptophysin. Two of three tumors were reactive for both bovine and porcine chromogranin A. These immunohistochemical results confirm the neuroendocrine nature of these tumors. Neuroendocrine cells could not be detected in the nasal mucosa and maxillary sinuses of a normal horse; therefore, the origin of these carcinoid tumors remains obscure.

Role of navicular bone shape in the pathogenesis of navicular disease: a radiological study.

From progeny lists of 30 Dutch Warmblood sires, 586 3-year-old females by these stallions were randomly selected, each progeny group aimed at 20 animals for statistical reasons. The front feet of the sires and female progeny were examined radiographically using lateromedial and dorsopalmar upright pedal projections. The radiological features associated with navicular disease were classified 0-4 using a standardised classification, grades 3 and 4 representing the more severe changes. The shape of the proximal articular border of the navicular bone outline on the dorsopalmar view was classified 1-4; 1=concave; 2=undulating; 3=straight; 4=convex. A significant shape-grade association was found, the highest grades 3 and 4 incidence demonstrated by shape 4. In shapes 1 and 2, navicular bones grades 3 and 4 features were mainly characterised by inverted flask-shaped channels. In shape 3, navicular bones grades 3 and 4 were dominated by enthesiophytes. These findings indicate an apparent shape predisposition to radiological changes associated with navicular disease. The shape of the navicular bone in the offspring was on average the same as the sire, indicating an hereditary element in navicular bone shape.

Aseptic tenosynovitis of the digital flexor tendon sheath, fetlock and pastern annular ligament constriction.

The anatomy of the digital flexor tendon sheath and related tendons and ligaments is described. Diagnosis and management of acute tenosynovitis and long-term tenosynovitis and associated tendon injuries are discussed, as well as the syndrome of stenosis of the fetlock canal (or fetlock annular ligament constriction) and palmar annular ligament constriction. Desmitis of the palmar annular ligament is also described.

Soft tissue injuries of the tarsus.

Contrast radiography provides a clear survey of the size, shape, and location of extratendovaginal fluid-filled cavities, distended bursa, and tendon sheaths and demonstrates intersynovial communication. Ultrasonography effectively demonstrates Achilles tendon injury, slippage of the SDFT off the summit of the calcaneus, assorted ligamentous injuries, and cystic or solid extratendovaginal masses. It will also demonstrate distended bursae and tendon sheaths, but it is not as effective in demonstrating a synovial herniation, or a narrow synovial fistula. Contrast radiography may prove to be the imaging modality of choice for examination of fluctuating swellings, whereas ultrasonography is preferred for the assessment of firm swellings. Routine radiographic evaluation in the clinical assessment of soft tissue injuries in the hock region continues to play an invaluable diagnostic role.

Miscellaneous conditions of tendons, tendon sheaths, and ligaments.

The use of diagnostic ultrasonography has greatly enhances our ability to diagnose injuries of tendons and tendon sheaths that were previously either unrecognized or poorly understood. For may of these injuries, there is currently only a small amount of follow-up data. This article considers injuries of the deep digital flexor tendon and its accessory ligament, the carpal tunnel syndrome soft tissue swellings on the dorsal aspect of the carpus, intertubercular (bicipital) bursitis and bicipital tendinitis, injuries of the gastrocnemius tendon, common calcaneal tendinitis, rupture of peroneus (fibularis tertius) and ligaments injuries of the back.

Bipartite distal sesamoid bones in a Holstein-Friesian calf.

Bipartite distal sesamoid bones were observed in the medial digits of both forelimbs of a six-month-old Holstein-Friesian calf. This paper describes the clinical and radiological (including computed tomographic) findings, and the therapy and follow-up of the case.

Ultrasonographic evaluation and long-term follow-up of flexor tendonitis/desmitis in the metacarpal/metatarsal region in Dutch warmblood horses and standardbred racehorses.

Over a 2 year-period, the ultrasonographic localization and distribution of flexor tendinous and ligamentous injuries, the long-term follow-up, and the outcome were studied in 101 Dutch Warmblood horses (DW) with a mean age of 8.7 years and in 71 Standardbred racehorses (ST) with a mean age of 5.2 years. The ratio between forelimb and hind limb flexor tendonitis/desmitis in the DW-group was 4:1 and in the ST-group group 4:3. In the DW-group, tendonitis/desmitis of the suspensory ligament (32%), the superficial digital flexor tendon (29%), the distal carpal check ligament (17%) of the forelimb (SLf, SDFf, and CL, respectively) and the suspensory ligament (11%) of the hind limb (SLh) occurred the most often. In the ST-group, tendonitis of the SDFf (34%) and desmitis of the SLh (34%) and SLf (18%) were the most common injuries. Of the 60 Dutch Warmblood horses available for follow-up, 25% showed full-functional recovery. Of the 61 Standardbreds available for follow-up, 18% showed full-functional recovery. Overall, local axial lesions seemed to have a worse prognosis than local abaxial or diffusive lesions.

Ultrasonographic assessment of the proximal digital annular ligament in the equine forelimb.

Ultrasonography was used with 6 normal cadaver forelimbs of Dutch Warmblood horses to delineate the ultrasonographic anatomy of the palmar pastern region, with emphasis on the proximal digital annular ligament. Using a 5.5 MHz sector scanner, the thin proximal digital annular ligament was not visible on offset sonograms. Only if the digital sheath in the normal limb was distended was the distal border of this ligament outlined. In all normal limbs the palmarodistal thickness of the combined skin-proximal digital annular ligament layer in the mid-pastern region was 2 mm. The flexor tendons and distal sesamoidean ligaments were easily identified as hyperechoic structures. Distension of the digital sheath in the normal limbs clearly outlined the anechoic digital sheath pouches. In 4 lame horses ultrasonography aided the diagnosis of functional proximal digital annular ligament constriction. In all 4 diseased forelimbs ultrasonography demonstrated thickening of the skin-proximal digital annular ligament layer and distension of the digital sheath. In one of these limbs the distended digital sheath was also thickened. The flexor tendons and distal sesamoidean ligaments were normal. There was no radiographic evidence of additional bone or joint lesions.