Systemic sclerosis medications and risk of scleroderma renal crisis.

BACKGROUND: Scleroderma Renal Crisis (SRC) is associated with significant morbidity and mortality. While prednisone is strongly associated with SRC, there are no previous large cohort studies that have evaluated ace inhibitor (ACEi) calcium channel blocker (CCB), angiotensin receptor blocker (ARB), endothelin receptor blocker (ERB), non-steroidal anti-inflammatory drug (NSAID), fluticasone, or mycophenolate mofetil (MMF) use in systemic sclerosis (SSc) and the risk of SRC. METHODS: In this retrospective cohort study of the entire military electronic medical record between 2005 and 2016, we compared the use of ACEi, ARB, CCB, NSAID, ERB, fluticasone, and MMF after SSc diagnosis for 31 cases who subsequently developed SRC to 322 SSc without SRC disease controls. RESULTS: ACEi was associated with an increased risk for SRC adjusted for age, race, and prednisone use [odds ratio (OR) 4.1, 95% confidence interval (CI) 1.6-10.2, P = 0.003]. On stratified analyses, ACEi was only associated with SRC in the presence [OR 5.3, 95% CI 1.1-29.2, p = 0.03], and not the absence of proteinuria. In addition, a doubling of ACEi dose [61% vs. 12%, p < 0.001) and achieving maximum ACEi dose [45% vs. 4%, p < 0.001] after SSc diagnosis was associated with future SRC. CCB, ARB, NSAIDs, ERB, fluticasone, and MMF use were not significantly associated with SRC. CONCLUSION: ACEi use at SSC diagnosis was associated with an increased risk for SRC. Results suggest that it may be a passive marker of known SRC risk factors, such as proteinuria, or evolving disease. SSC patients that require ACEi should be more closely monitored for SRC.

Anti-Myeloperoxidase Antibodies Associate with Future Proliferative Lupus Nephritis.

BACKGROUND: The subclinical pathophysiology of proliferative lupus nephritis (PLN) has not been fully elucidated. Myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) is associated with PLN, but prediagnostic levels have not been reported. METHODS: We performed a retrospective case-control Department of Defense Serum Repository (DoDSR) study comparing MPO-ANCA levels in longitudinal prediagnostic serum samples for 23 biopsy confirmed proliferative lupus nephritis (PLN) patients to DoDSR identified age, sex, race, and age of serum matched healthy and SLE without LN disease controls. We also compared the temporal relationship of MPO-ANCA to anti-double stranded DNA antibodies (dsDNAab). RESULTS: A greater proportion of PLN patients had prediagnostic MPO-ANCA levels above ≥3 U/mL and ≥6 U/mL compared to SLE without LN (91% versus 43%, p < 0.001; 57% versus 5%, p < 0.001, resp.). In subgroup analysis, the MPO-ANCA threshold of ≥3 U/mL was significant at <1 year (88% versus 39%, p = 0.007) and 1-4 years (87% versus 38%, p = 0.009) prior to diagnosis. Statistically significant subclinical MPO-ANCA levels (≥3 U/mL) occurred prior to statistically significant dsDNAab ≥ 3 IU/ml (89% versus 11%, p = 0.003). CONCLUSIONS: Subclinical MPO-ANCA levels could distinguish future PLN from SLE without LN. MPO-ANCA manifests prior to clinical disease and subclinical dsDNAab to suggest that it may contribute directly to PLN pathogenicity.

Planned wedge size compared to achieved advancement in dogs undergoing the modified Maquet procedure.

OBJECTIVES: To evaluate the patellar ligament to tibial plateau angle (PL-TPA) and amount of achieved advancement in dogs that underwent the modified Maquet procedure; compare wedge sizes recommended using two different planning techniques (Orthomed and modified tibial tuberosity advancement); and evaluate anatomical factors that predict the wedge size required to obtain a 90° PL-TPA. METHODS: Pre- and postoperative radiographs of dogs that had a modified Maquet procedure performed were evaluated for the following: calculated wedge size using two different planning techniques, the actual wedge size used, the achieved tibial tuberosity advancement, and the changes in PL-TPA. Anatomical measurements of the tibia were evaluated and correlated with the actual wedge size. RESULTS: Of the 38 modified Maquet procedures identified, 53% (n = 20) had a PL-TPA of 90° ± 5°. Actual achieved advancement of the tibial tuberosity was 30% less than the wedge size used. Changes in PL-TPA and tibial width persisted at eight weeks postoperatively without loss of advancement. The two planning techniques did not result in a significantly different selection of wedge size. CLINICAL RELEVANCE: Current planning techniques for the modified Maquet procedure result in under-advancement of the tibial tuberosity. Both measurement techniques evaluated do not result in appropriate advancement.

Variability associated with assessing changes in position of a canine uncemented femoral stem prosthesis.

OBJECTIVE: Evaluate variability associated with assessing changes in the position of uncemented femoral stems. METHODS: Stem level, canal fill, stem angle, and version angle were measured on craniocaudal horizontal beam (CCHB) and open leg lateral (OLL) radiographic projections of the femur of 20 dogs that had uncemented total hip replacement. Intraobserver and interobserver repeatability were determined on immediate postoperative (PO) images. Differences in position were calculated between the first (3 months - R1) and second (6 months - R2) re-evaluation (R1-R2) time points, and between PO and R1. RESULTS: The measurement process was very repeatable. For R1-R2, the stem appeared to subside 0.8 ± 1.4 mm for measurements based on the greater trochanter on the CCHB images, but there was a wide range (-3.9 to 2 mm; positive values indicate proximad movement). Measurements based on the intertrochanteric crest on the OLL images had the same mean, and also a wide range (-4.4 to 2.1 mm; negative values indicate proximad movement). For PO-R1, the stem appeared to subside 1.8 ± 2.0 mm (CCHB, based on the greater trochanter, range -7.7 to 2.2 mm), 1.6 ± 1.5 mm (CCHB, based on the intertrochanteric crest, range -0.7 to 4.3 mm); and 2.1 ± 2.1 mm (OLL, based on the intertrochanteric crest, range -1.6 to 6.8 mm). CONCLUSION: The position of a stable stem can appear different on subsequent re-evaluations, but this may be due to variability associated with inconsistency of positioning of the patient and limb. CLINICAL SIGNIFICANCE: Documenting subsidence in individual patients should not rely on calculations based on a single measurement.

Single-stage bilateral tibial tuberosity advancement for treatment of bilateral canine cranial cruciate ligament deficiency.

OBJECTIVE: To report complications in dogs with naturally occurring cranial cruciate ligament rupture following single-stage bilateral tibial tuberosity advancement (SS-BTTA) procedures, and to compare these complications to a population of dogs undergoing unilateral tibial tuberosity advancement (UTTA). METHODS: Medical records and radiographs of client-owned dogs treated with tibial tuberosity advancement between August 2008 and December 2011 were reviewed. Forty-four client-owned dogs with bilateral cranial cruciate ligament rupture that underwent SS-BTTA procedures and 82 client-owned dogs that underwent UTTA procedures were randomly selected from our hospital population. Complications were recorded and analysed. Major complications were defined as fractures or any complication requiring a second surgery. Minor complications were any problem identified that did not require surgical management. RESULTS: Incidence for major and minor complications in the UTTA group was 2.3% and 24.4%, respectively. Incidence for major and minor complications in the SS-BTTA group was 12.5% and 26.1%, respectively. Single-stage bilateral tibial tuberosity advancement procedures had a four- to five-fold increase in odds of a major complication (p <0.050) compared to UTTA. CLINICAL SIGNIFICANCE: The findings of our study indicate that SS-BTTA procedures are associated with an increased risk of major complications compared to UTTA procedures.

Acetabular cup liner and prosthetic head exchange to increase the head diameter for management of recurrent luxation of a prosthetic hip in two dogs.

Component malalignment and impingement are possible causes of recurrent luxation following total hip replacement in the dog. In the two cases presented in this report, luxation that was probably due to impingement was managed by exchanging the standard 17 mm prosthetic head for a 24 mm prosthetic head. This required removal of the original acetabular cup liner and placement of a new polyethylene liner that would accept the 24 mm head into the stable acetabular shell. In the first case, a 50 kg Malamute dog, recurrent luxation was initially managed by component alignment revision, iliofemoral suture, triple pelvic osteotomy and a novel lasso technique, without long-term success. After exchanging the head and cup liner, luxation did not recur over a 12-month period. In the second case, a 65 kg Newfoundland dog, impingement was suspected after a second luxation event. Luxation did not recur during the nine months after exchange of the head and cup liner. The larger prosthetic head used in these two cases increased the impingement-free range-of-motion of the joint and increased the translation distance required for luxation (jump distance).

Revision of a loose cementless short-stem threaded femoral component using a standard cementless stem in a canine hip arthroplasty.

A Helica short-stemmed femoral prosthesis that was identified as being loose one year after implantation was revised with a standard long stem cementless BFX femoral prosthesis. A double pelvic osteotomy was also performed to improve the orientation of the stable acetabular cup. Despite complete resorption of the femoral neck, and a large perforation of the lateral femoral cortex, the revision stem did not subside or rotate. The prosthetic joint did not dislocate. At re-evaluation two years after revision surgery, the prosthetic components were stable. Signs of bone ingrowth into the stem and cup were evident on radiographs. The dog had a seven percent greater thigh muscle girth in the limb implanted with the hip prosthesis compared to the contralateral limb, and was very active with no lameness.

Annealing dynamics of waveguide Bragg gratings: evidence of femtosecond laser induced colour centres.

There is still significant speculation regarding the nature of femtosecond laser induced index change in bulk glasses with colour centre formation and densification the main candidates. In the work presented here, we fabricated waveguide Bragg gratings in doped and undoped phosphate glasses and use these as a diagnostic for monitoring subtle changes in the induced refractive index during photo- and thermal annealing experiments. Reductions in grating strengths during such experiments were attributed to the annihilation of colour centres.

Evaluation of a therapeutic diet for feline degenerative joint disease.

BACKGROUND: Feline degenerative joint disease (DJD) is common and there are no approved therapies for the alleviation of the associated pain. OBJECTIVE: To test a diet high in eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) content and supplemented with green-lipped mussel extract and glucosamine/chondroitin sulfate (test-diet) for its pain-relieving and activity-enhancing effects in cats with painful, mobility-impairing DJD over a 9-week period. ANIMALS: Forty client-owned cats. METHODS: Randomized, controlled, blinded, parallel group, prospective clinical study. Cats with no detectable systemic disease, and with at least 1 appendicular joint with radiographic evidence of DJD where manipulation elicited an aversive response were included. Cats were randomly allocated to the test-diet or control diet (C-diet). Outcome measures were subjective owner and veterinarian assessments, and objective activity monitoring (accelerometry). Nonparametric statistics were used to evaluate changes within and between groups for both subjective and objective data, and locally weighted scatterplot smoothing regression analysis was used to predict activity changes. RESULTS: The primary objective outcome measures indicated that activity declined significantly (P < .001) in the C-diet group, significantly increased (P < .001) in the test-diet group and there was a significant difference between the groups (P < .001). CONCLUSION AND CLINICAL IMPORTANCE: A diet high in EPA and DHA and supplemented with green-lipped mussel extract and glucosamine/chondroitin sulfate improved objective measures of mobility. Dietary modulation might be 1 method to use to improve mobility in cats with DJD-associated pain.

Total hip replacement in three cats: surgical technique, short-term outcome and comparison to femoral head ostectomy.

OBJECTIVE: To describe the surgical technique and clinical features of total hip replacement (THR) due to hip trauma in cats. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Three client-owned cats that underwent THR to treat capital epiphyseal fractures, and five client-owned cats that underwent femoral head ostectomy (FHO). METHODS: The clinical data included signalment, body weight, body condition score, diagnosis, implant size, surgical technique, intraoperative observations, and postoperative complications. Radiographic evaluation included implant positioning, cement mantle quality, and follow-up examination of the cement-bone interfaces. Orthopaedic examinations and client interviews were used to evaluate limb function. RESULTS: The three cats that underwent THR had a mean body weight of 5.5 kg, a mean body condition score of 6/9, and a mean age of three years at the time of surgery. The average THR follow-up was 11 months. For the five cats that underwent FHO, the mean body weight was 6.3 kg, mean body score was 7/9, and mean age at the time of FHO was 2.5 years. The average FHO follow-up was 22 months. Hip flexion, hip extension, and thigh girth after THR compared favourably to similar measurements made after FHO. The functional outcomes after THR were excellent. The functional outcomes after FHO ranged from poor to excellent. CONCLUSION AND CLINICAL RELEVANCE: The recovery after THR was excellent based on clinical assessment of muscle mass, hip joint passive range of motion, gait, and owner assessment. Further blinded, randomised, and controlled trials of THR in cats are warranted.

Amantadine in a multimodal analgesic regimen for alleviation of refractory osteoarthritis pain in dogs.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) do not always provide sufficient pain relief in dogs with osteoarthritis (OA). HYPOTHESIS: The use of amantadine in addition to NSAID therapy will provide improved pain relief when compared with the use of nonsteroidal analgesics alone in naturally occurring OA in dogs. ANIMALS: Thirty-one client-owned dogs with pelvic limb lameness despite the administration of an NSAID. METHODS: The study was randomized, blinded, and placebo controlled with parallel groups (days 21-42). On day 0, analgesic medications were discontinued. On day 7, all dogs received meloxicam for 5 weeks. On day 21, all dogs received amantadine (3-5 mg/kg once daily per os) or placebo for 21 days, in addition to receiving meloxicam. Assessments were performed before the study and on days 7, 21, and 42. Primary outcome measures were blinded owner assessments of activity using client-specific outcome measures (CSOM) on days 0, 7, 21, and 42. Data were analyzed by a mixed model approach. RESULTS: For CSOM activity, there was a significant time by treatment effect (P=.009). On the basis of the planned post hoc t-tests of postrandomization means, there was a significant difference between treatment groups on day 42 (P=.030), with the amantadine group being more active. CONCLUSIONS AND CLINICAL IMPORTANCE: In dogs with osteoarthritic pain refractory to an NSAID, physical activity is improved by the addition of amantadine. Amantadine might be a useful adjunct therapy for the clinical management of canine osteoarthritic pain.

Morphology and correction of distal tibial valgus deformities.

OBJECTIVES: To characterise distal tibial valgus deformities in dogs through physical examination and radiographic evaluation. METHODS: In a clinical study of 16 client-owned dogs, twelve unilateral and four bilateral distal tibial valgus deformities were evaluated using palpation and radiographs. The origin and amplitude of angulation, rotation and length deficits if present were measured. Radiographically, fibular length and position in relation to the tibia was compared in affected and clinically normal limbs. The dimensions of the fibular physes were also compared between clinically normal and affected limbs. RESULTS: Rottweilers and Shetland sheepdogs were overrepresented. Valgus deformities ranged from 16 degrees to 48 degrees (median, 32 degrees ) in affected and from 0 degrees to 13 degrees (median, 6 degrees ) in contralateral, clinically normal limbs. Fibular length, fibular position relative to the tibia or physeal dimensions were not statistically different between affected and clinically normal limbs. CONCLUSION AND CLINICAL RELEVANCE: Many distal tibial valgus deformities in dogs are a uniplanar deformity without concurrent craniocaudal or rotational changes or length deficits. A growth cessation in the fibula does not appear to be responsible for the development of the deformity.

Cranial cruciate ligament rupture in large and giant dogs. A retrospective evaluation of a modified lateral extracapsular stabilization.

Forty-two dogs weighing between 30 and 87 kg (mean body weight of 49 kg) with cranial cruciate ligament ruptures (CCLR) were treated with a modified lateral extra-capsular stabilization using braided polyester prosthetic ligament-suture anchor technique. Clinical and radiographic outcomes of 48 stifles were retrospectively evaluated with a mean follow-up of 18 months. Ten dogs had pulled out their bone anchors with no clinical relevance. Draining tracts did not appear. Despite mild radiographic progression of osteoarthritis, all of the dogs regained acceptable function of the operated limb.

Management of 49 antebrachial and crural fractures in dogs using circular external fixators.

OBJECTIVES: To evaluate frame constructs, postoperative fracture reduction, postoperative care, complications, treatment duration and outcome of circular external fixation for management of 49 antebrachial and crural fractures in dogs. METHODS: Medical records of dogs that underwent surgery with circular external fixation were examined for fracture location, frame configuration, postoperative fracture reduction, treatment duration, complications and outcome. RESULTS: Forty-nine fractures in 48 dogs were stabilised using circular external fixation. Frame removal occurred on average 61 days after surgery (median+/-sd, 52+/-30 days). Minor complications were observed in 35 cases (71 per cent) and major complications in seven (14 per cent). Radiographic outcome at frame removal was judged as excellent in 18 cases (37 per cent), as good in 26 (53 per cent), as fair in four (8 per cent) and poor in one (2 per cent). After frame removal, one fracture was stabilised with a plate, and eight patients were lost to follow-up. Functional and cosmetic outcome at follow-up was judged as excellent in 32 cases (80 per cent), good in seven (18 per cent) and fair in one (2 per cent). CLINICAL SIGNIFICANCE: Circular external fixation can effectively treat antebrachial and crural fractures in dogs, even geometrically complex fractures. Minor complications are frequent but easily managed in most instances. Healing time is comparable to that of other external fixation methods.

Stabilisation of scoliosis in two koi (Cyprinus carpio).

Two koi (Cyprinus carpio) from the same pond developed similar lesions of scoliosis. Radiographic examinations showed that their spines had become malaligned as a result of vertebral compression fractures involving T14 to T16. The vertebrae in both fish were stabilised with screws, k-wire and polymethylmethacrylate. They both appeared to improve after surgery, but they began to decline and died within three months. A postmortem examination revealed multi-organ inflammation that was not associated with the surgical implants.

Incomplete ossification of the humeral condyle in two Labrador retrievers.

Incomplete ossification of the humeral condyle (IOHC) was identified in two Labrador retrievers using computed tomography. Both dogs were non-weightbearing on the affected forelimbs. The dogs were treated by means of a bone screw placed across the humeral condyle. IOHC was originally reported in spaniel and chondrodystrophic breeds. The pathogenesis of the condition remains unknown, but may be related to impaired antebrachial bone growth, similarly to the pathogeneses of elbow dysplasia and radius curvus.

Femoral medullary infarction secondary to canine total hip arthroplasty.

OBJECTIVE: To evaluate the prevalence of femoral intramedullary infarction after total hip arthroplasty (THA) and to determine whether any specific femoral morphology predisposes to bone infarction. STUDY DESIGN: Retrospective clinical study. SAMPLE POPULATION: All dogs from our hospital population undergoing THA between 1984 and 1997 with radiographic follow-up available at 1 year or more postoperatively. METHODS: A case control study was conducted within the THA group to determine risk factors predisposing to femoral infarction after THA. Medical records and radiographs were reviewed. Data were collected on clinical parameters, femoral morphology, prosthesis, and bone changes. Radiographic diagnosis was confirmed using histopathology in 11 femora. Radiographs of 50 age-matched control dogs weighing more than 20 kg with coxofemoral degenerative joint disease were randomly chosen to determine the prevalence of bone infarction in nonoperated dogs. RESULTS: Ninety-one dogs with 110 THA were included in the study. Fifteen of the 110 femora with THA had radiographic evidence of infarction (14%). Infarction was not present in any femora in the control group. There was no significant difference in the prevalence of infarction between dogs that received cemented or uncemented prostheses. Clinical signs were not reported in any patient that developed femoral infarction. Young age (P = .03) and a distance between the greater trochanter and nutrient foramen greater than 79 mm (P = .008) predisposed dogs to femoral infarction. Over time, three infarcts decreased in size radiographically, five remained unchanged, and three expanded. An osteosarcoma developed at the site of a bone infarct in one dog. CONCLUSION: Femoral intramedullary infarction occurred in 15 of 110 THA. Young age at the time of THA and a greater distance between the greater trochanter and the nutrient foramen predisposed to infarction. CLINICAL RELEVANCE: Intramedullary infarction occurs after canine THA. These bone infarcts do not appear to cause clinical signs; however, they may present a diagnostic challenge. Malignant transformation could potentially result from medullary infarction.

Fracture treatment with circular external fixation.

Circular external skeletal fixation (CEF) has been used in recent years to treat acute and chronic fractures and bone deformities, to stabilize joints while maintaining range of motion, and to perform arthrodeses and limb-sparing in dogs. Dr. Ilizarov defined the general principles and methods of CEF. This article reviews these principles. It also describes the indications, preoperative planning, surgical placement, postoperative management, clinical results, and complications of CEF used to treat fractures in dogs.

Canine uncemented porous-coated anatomic total hip arthroplasty: results of a long-term prospective evaluation of 50 consecutive cases.

OBJECTIVE: To evaluate the long-term clinical and radiographic results of a canine uncemented porous-coated anatomic (PCA) total hip arthroplasty (THA). STUDY DESIGN: Prospective study of consecutive clinical patients using survival analysis. ANIMALS: Forty-one dogs that underwent PCA THA; nine had bilateral PCA THA (50 prostheses). METHODS: Gait observation, orthopedic examination, and radiographic assessment were conducted before THA, 6 months after THA, and yearly thereafter. A zonal analysis system was used to document osseous changes in the femur and the acetabulum. Acetabular cup and femoral stem subsidence and migration, femoral canal fill, and implant orientation were measured. Survival analysis of the procedure was conducted. RESULTS: Long-term follow-up was available for 37 dogs (46 prostheses). The median follow-up was 63 months. Limb function was normal for 37 limbs and abnormal for 9 limbs because of dislocation (n = 3), lumbosacral disease (n = 2), degenerative myelopathy (n = 1), autoimmune disease (n = 1), brain tumor (n = 1), or osteosarcoma of the femur (n = 1). All prosthetic stems and cups were fixed by bone ingrowth fixation. Osteolysis was not observed. Bone infarction occurred in five femoral canals (four dogs). The 6-year survival rate for the procedure was 87% (95% confidence interval, 72%-96%). CONCLUSIONS: Long-term fixation of the uncemented PCA acetabular cup and stem is successful in dogs, and long-term clinical function is excellent.

Osteosarcoma at the site of bone infarction associated with total hip arthroplasty in a dog.

OBJECTIVE: To report the occurrence of medullary bone infarction in both femoral canals after bilateral total hip arthroplasty (THA) and the subsequent unilateral development of an osteosarcoma at the site of bone infarction. STUDY DESIGN: Clinical report. ANIMAL POPULATION: An 8-month-old neutered male Samoyed dog. METHODS: Serial physical and radiographic examinations performed at 1, 2, 3, and 5 years after THA. Bone biopsy specimens of the right distal femoral metaphysis were taken 5 years after THA, and a complete necropsy was performed at the time of euthanasia. RESULTS: Bilateral medullary bone infarction was visible in the femoral canals 1 year after THA and remained visible on subsequent evaluations. An osteosarcoma developed in the right distal femoral metaphysis at the site of infarction, 5 years after THA, and was found to have metastasized widely throughout the body. CONCLUSION: Bone infarction may occur in the femoral canal after canine THA. CLINICAL RELEVANCE: Bone infarction may be a predisposing factor for the development of osteosarcoma in the femora of dogs with THAs.