Correlations between mean echogenicity and material properties of normal and diseased equine superficial digital flexor tendons: an in vitro segmental approach.

The objective of this study was to test the hypothesis that tendon echogenicity is associated with the material properties of the corresponding tendon site, especially in case of lesions, due to local changes in tendon matrix composition. Four normal and nine spontaneously injured equine superficial digital flexor tendons (SDFT) were isolated then ultrasonographically examined under tension, in a special device placed in a water bath. Ultrasonographic transversal images (7.5MHz linear transducer) of five segments along each tendon were digitized, and analyzed in order to measure the mean cross-sectional area (MCSA) and mean echogenicity (ME) of each segment. The tendons were then tested in traction until rupture in a testing machine. For each segment, stress and strain were determined throughout the test, and the elastic modulus (EM) was evaluated. The tendon lesions were also documented by histology. No correlation was found between ME and the material properties of normal tendon segments. At the rupture sites of the nine diseased tendons, ME was positively correlated with maximal stress and EM, whereas no correlation was demonstrated with maximal strain. Besides, a positive correlation was demonstrated between ME and both MCSA and EM, when the three metacarpal segments of the diseased tendons were considered. Although ME gives only rough information about tendon matrix structure, it does show, under these in vitro conditions, significant correlations with material properties of pathological tendon segments, which may improve the functional significance and therefore the prognostic value of the ultrasonographic examination of tendon lesions.

Detection of antibodies to Aspergillus fumigatus in serum of horses with mycosis of the auditory tube diverticulum (guttural pouch).

OBJECTIVE: To detect antibodies against Aspergillus fumigatus antigens in serum samples from horses and to evaluate the relevance of this method as an alternative approach to the diagnosis of mycosis of the auditory tube diverticulum (guttural pouch mycosis [GPM]). ANIMALS: Twelve clinically normal horses (controls) and 12 horses with GPM diagnosed by endoscopic observation of characteristic mycotic plaques. PROCEDURE: Antibodies to A fumigatus antigens were detected in serum by use of an ELISA and immunoblot analysis with extracellular antigens. RESULTS: Antibodies against A fumigatus antigens were found in healthy and diseased horses. Titer of total Aspergillus antibodies was not diagnostic for GPM. In contrast, immunoblot analysis results indicated that 2 antigens of 22 and 26 kd were constantly recognized by sera from diseased horses. CONCLUSIONS: Reactivity to 22- and 26-kd A fumigatus antigens, as measured by immunoblot analysis, seemed to be diagnostic for GPM in horses.

Mechanical properties of pathological equine superficial digital flexor tendons.

The objective of this study was to mechanically characterise superficial digital flexor tendon (SDFT) lesions. Eight pathological SDFTs, isolated from 6 adult horses, were tested in traction until rupture (at 1 mm/s). The stresses and strains simultaneously undergone by each of the 7 segments of a tendon were determined throughout the test, and the modulus of elasticity of each segment was evaluated from the segmental stress-strain curve thus obtained. These mechanical data were compared to those obtained on 10 normal SDFTs. After the test, the tendinous segments were submitted to a histological examination in order to characterise the tissues. Three lesional categories (I to III, of increasing maturity), as well as the normal tendinous tissue, were defined and assessed quantitatively according to their extent in the histological sections. The most recent and severe lesions (categories I and II) were correlated with a large degree of hypertrophy (often above 200%) of the corresponding segments, with a resulting decrease in the stress at tendon rupture, and a slight decrease in the strain at tendon rupture in spite of a low modulus of elasticity (low stiffness). In contrast, the adjacent areas, less or not injured, underwent compensatory strains. This relative overstraining was especially critical with category III tissue, often present in the transitional areas between sound and severely injured segments. Here the modulus of elasticity was low whereas the hypertrophy was only slight. Therefore, the corresponding segments seemed to be the most fragile sites, and those most predisposed to recurring injury, in an injured SDFT.

Segmental variations of in vitro mechanical properties in equine superficial digital flexor tendons.

OBJECTIVE: To determine the local variations of mechanical properties of the equine superficial digital flexor tendon (SDFT). SAMPLE POPULATION: 10 SDFT of adult horses, selected for absence of abnormality. PROCEDURE: Needles (with a dark marker at both ends) pinned perpendicularly through each tendon to delimit 7 segments. Each tendon was tested in traction until rupture; test was filmed, using an 8-mm video camera. For each image, the coordinates of the center of mass of each marker and the corresponding force were registered. The third-degree polynomial that best fits the stress-strain curve thus obtained was calculated by a least squares approximation. The modulus of elasticity (Emax) of each segment was evaluated as the maximum of the derivative of this polynomial. RESULTS: Mean rupture load of the 10 SDFT was 12,356 +/- 1,333 N. The strain at tendon rupture and Emax varied, respectively, from 8.1 +/- 1.3% and 1,002 +/- 161 MPa (sesamoidean region) to 12.5 +/- 1.7% and 1,189 +/- 63 MPa (metacarpal region). The values of the strain corresponding to Emax were remarkably similar along the SDFT (approx 5%). CONCLUSIONS: Emax appeared early homogeneous along an SDFT, although being slightly higher in the metacarpal region. The 5% strain corresponding to Emax could be the limit strain beyond which microlesions of the tendinous fibers begin to appear, this threshold being first reached during the traction test by the metacarpal segments.

Duodenogastric bile reflux and gastrointestinal motility in pathogenesis of functional dyspepsia. Role of cholecystectomy.

To establish the pathogenic role of duodenogastric reflux in dyspeptic symptoms we have compared the clinical features, gastrointestinal motility, and rates of duodenogastric bile reflux in 12 cholecistectomized dyspeptic patients, 12 dyspeptic patients with intact gallbladder, and 12 healthy controls. Specific symptoms were scored for severity and frequency. Gastrointestinal manometry was performed during 3 hr of fasting and 2 hr postprandially. Simultaneously, samples of duodenal and gastric contents were obtained sequentially for quantification of bile acids. Results show that symptom global severity (9.6 +/- 0.4 vs 8.8 +/- 0.7) and frequency (9.9 +/- 0.8 vs 9.0 +/- 0.5) were similar in both dyspeptic groups; only abdominal pain was milder in cholecystectomized patients (1.9 +/- 0.1 vs 2.6 +/- 0.2; P < 0.05). Fasting gastric bile acid concentrations were higher in cholecystectomized patients (P < 0.05) and antral postcibal motility lower (P < 0.05) than in the groups. No relation among gastric hypomotility, duodenogastric bile reflux, and symptom scores was detected. We concluded that patients with functional dyspepsia and a prior cholecystectomy have clinical features similar to those with gallbladders, but some physiological features are dissimilar: antral motility is decreased and duodenogastric bile reflux is increased. Thus, a uniform clinical expression of various pathophysiological disturbances constitutes the basis of functional dyspepsia.

Does Helicobacter pylori infection increase gastric sensitivity in functional dyspepsia?

The role of Helicobacter pylori infection in the pathogenesis of functional dyspepsia is debated. It is known that a substantial fraction of dyspeptic patients manifest a low discomfort threshold to gastric distension. This study investigated the symptomatic pattern in 27 H pylori positive and 23 H pylori negative patients with chronic functional dyspepsia, and potential relations between infection and gastric hyperalgesia. Specific symptoms (pain, nausea, vomiting, bloating/fullness, early satiety) were scored from 0 to 3 for severity and frequency (global symptom scores: 0-15). The mechanical and perceptive responses to gastric accommodation were evaluated with an electronic barostat that produced graded isobaric distensions from 0 to 20 mm Hg in 2 mm Hg steps up to 600 ml. Gastric compliance (volume/pressure relation) and perception (rating scale: 0-10) were quantified. Standard gastrointestinal manometry and recorded phasic pressure activity at eight separate sites during fasting and postprandially were also assessed. H pylori positive and H pylori negative patients manifested similar severity and frequency of specific symptoms and global symptom scores (mean (SEM)) (severity: 9.5 (2.0) v 9.0 (2.1); frequency: 10.8 (2.0) v 9.7 (2.2)). No differences were seen either in gastric compliance (53 (4) ml/mm Hg v 43 (3) ml/mm Hg) or in gastric perception of distension (slope: 0.50 (0.05) v 0.53 (0.06)). Postprandial antral motility was significantly decreased in H pylori positive patients (two hours motility index: 10.4 (0.6) v 12.6 (0.5); p < 0.05). It is concluded that H pylori infected patients with functional dyspepsia present no distinctive symptoms by comparison with H pylori negative counterparts and H pylori infection is associated with diminished postprandial antral motility but it does not increase perception of gastric distension.