Clinical features and outcome of functional thyroid tumours in 70 dogs.

OBJECTIVE: To describe the clinical features and outcome of functional thyroid tumours in dogs. MATERIALS AND METHODS: Retrospective multi-institutional study of 70 dogs diagnosed with thyroid mass and concurrent hyperthyroidism. Clinical data regarding presentation, treatment, outcome and functional thyroid status were retrieved. RESULTS: Overall median survival of dogs with functional thyroid tumours was 35.1 months and 1- and 3-year survival rates were 83 and 49%, respectively. Median survival time was 72.6 months for dogs treated with surgical excision and 15.7 months for dogs that did not receive surgery. Of the 50 dogs treated by surgery and for which thyroid status was known following treatment, 64% developed hypothyroidism after surgery. Histopathologically confirmed metastasis was identified in 3% of dogs. CLINICAL SIGNIFICANCE: Dogs with functional thyroid tumours may survive a long time after surgical excision, although post-operative hypothyroidism is common.

Comparison of still image quality between traditional 35 mm digital and GoPro cameras in a surgical setting.

Intraoperative photography is used to obtain images for both education and research purposes, but poses challenges due concerns regarding aseptic technique. Waterproof digital cameras have sterilisable cases that can be used by the surgeon for intraoperative photography. We compared the quality of still intraoperative images obtained by a non-scrubbed observer using a 35 mm single lens reflex (SLR) camera to images obtained by the surgeon using a GoPro camera in a sterilised case. Image quality was scored using a 4 point Likert scale by 3 groups of end users with differing experience: faculty surgeons, surgical residents, and 3rd year veterinary students. Mean ± SEM overall image quality scores were higher for the traditional 35 mm digital SLR camera when compared to the GoPro (3.25 ± 0.08 vs. 2.0 ± 0.08, p < .0001), as were scores for each image characteristic (brightness, colour, sharpness, and contrast). Image quality scores for each camera also differed significantly between user groups, with expert users (faculty and residents) giving lower quality scores when compared to scores from novices (students). Findings suggest that GoPro cameras provide lower intraoperative image quality than digital SLR cameras, although lower quality images may be more accepted by novices than by experienced users.

Patent ductus arteriosus in cats (Felis catus): 50 cases (2000-2015).

OBJECTIVES: To describe signalment, clinical characteristics, diagnostic, treatment, and outcome data in a large case series of cats with patent ductus arteriosus (PDA). ANIMALS: Fifty cats with confirmed PDA. METHODS: Retrospective review of medical records from five referral veterinary hospitals for cats with PDA between 2000 and 2015. Cats were included if a PDA was visualized echocardiographically, during surgery, or on post-mortem examination. RESULTS: Median age at presentation was 6 months (range: 36 days-9.7 years; n = 50), and sex distribution was approximately equal (27 male, 23 female). Most cats did not have clinical signs (70.2%; 33/47) at the time of presentation. Murmurs were classified as continuous (55%; 22/40) or systolic (45%; 18/40). Echocardiography confirmed left-to-right shunting in 33 cats (82.5%; 33/40) and right-to-left shunting in 7 (17.5%; 7/40). Concurrent cardiac anomalies were identified in 54.5% (18/33) and pulmonary hypertension in 45.7% (16/35). Closure was pursued in 68% (34/50), and complications associated with the procedure occurred in 14.7% (5/34) of cats, including one intraoperative mortality. Long-term follow up was available in 80% (40/50) of cats. CONCLUSIONS: Cats with PDA often do not display clinical signs and may not have the characteristic physical examination findings typical of PDA in dogs. An increased prevalence of concurrent cardiac anomalies and pulmonary hypertension were found relative to previous reports. Thoracic radiographs and echocardiogram may provide the most comprehensive information for making a diagnosis and treatment recommendations. PDA closure was associated with a favorable long-term outcome in cats included in this study.

Retrospective evaluation of the efficacy of isolating bacteria from synovial fluid in dogs with suspected septic arthritis.

OBJECTIVE: To evaluate the efficacy of synovial fluid culture in obtaining the causative organism from dogs with suspected septic arthritis. METHODS: In this retrospective evaluation, synovial fluid cytology and microbiology submissions from dogs with suspected septic arthritis from March 2007 to August 2011 were reviewed. Synovial fluid cytology consistent with joint sepsis was identified. Cultures of synovial fluid from dogs with clinical histories and abnormalities consistent with septic arthritis were used to evaluate the efficacy of bacterial isolation. RESULTS: In total, 36 dogs met the inclusion criteria. Initial aerobic cultures of joint fluid yielded bacterial growth in 44% of these dogs. All anaerobic cultures were negative. In 19% of the dogs with positive cultures, antibiotics had been administered prior to arthrocentesis compared with 10% of dogs with negative cultures. There was no association between culture efficacy and the administration of antimicrobial treatment prior to synovial fluid culture or recent surgery involving the affected joint (P=0.637 and P=0.106, respectively). CONCLUSION: Culture of synovial fluid from dogs with suspected septic arthritis has a low yield, necessitating a more effective means of identifying bacteria from suspected septic joints in dogs.

Comparison of synovial fluid culture and 16S rRNA PCR in dogs with suspected septic arthritis.

OBJECTIVE: To prospectively compare the sensitivity and specificity of 16S rRNA PCR with culture for identifying the causative organism in synovial fluid obtained from dogs with suspected septic arthritis. METHODS: Synovial fluid cytology, PCR analysis and aerobic, anaerobic and Mycoplasma culture of samples from the affected joints of 18 dogs presenting with suspected septic arthritis were performed. Synovial fluid samples from the corresponding contralateral joints of 7 dogs were also analysed as negative controls. RESULTS: There was no significant difference between the sensitivity of bacterial detection via culture (63.2%) versus PCR (73.7%) of synovial fluid (P=0.728) or between culture and combined PCR and culture (89.5%) of synovial fluid (P=0.124). The specificity of PCR (42.9%) was significantly lower than culture specificity (100%) (P=0.07). CONCLUSION: Although 16S PCR may hold potential as an ancillary diagnostic test for identifying the causative organism in dogs with septic arthritis, our study failed to demonstrate improved accuracy compared with traditional synovial fluid culture.

Mental competence and surrogate decision-making towards the end of life.

German legislation demands that decisions about the treatment of mentally incompetent patients require an 'informed consent'. If this was not given by the patient him-/herself before he/she became incompetent, it has to be sought by the physician from a guardian, who has to be formally legitimized before. Additionally this surrogate has to seek the permission of a Court of Guardianship (Vormundschaftsgericht), if he/she intends to consent to interventions, which pose significant risks to the health or the life of the person under his/her care. This includes 'end-of-life decisions'. Deviations from this procedure are only allowed in acute emergencies or cases of 'medical futility'. On the basis of epidemiological and demographical data it can be shown that the vast majority of surrogate decisions on incompetent patients in Germany is not covered by legally valid consent. Moreover, the data suggests that if consent were to be requested according to the legal regulations, both the legal and medical system could realistically never cope with the practical consequences of this. Additionally, empiric research has revealed serious deficits concerning medical 'end of life-decisions' and practical performance in palliative care. As a consequence a multidisciplinary discussion has developed in Germany about the reform of present legislation with respect to key-issues like the assessment of mental competence, the options for exercising patient self-determination via advance directives and durable powers of attorney, the improvement of palliative care facilities, the clarification of formal procedures for surrogate decision-making in health care and towards the end of life and the possibilities and their limitations of controlling these decision-making processes 'externally' (e.g., by Guardianship Courts or committees). The authors discuss those proposals, which clearly dominate the present debate: They all aim to comply with the scientific basis of German law, jurisdiction and the European traditions of philosophy of health care and bioethics.

Monitoring of the infrared radiation emitted from skin layers during CO2 laser resurfacing: a possible basis for a depth navigation device.

CO2 laser resurfacing is very accurate, but it is not free of complications such as scarring. The objectives of the present study were to evaluate the pattern of the infrared (IR) radiation emitted from skin layers and to use this pattern to distinguish between these layers during resurfacing. A CO2-resurfacing laser (Sharplan SilkTouch) was used for the de-epithelialisation of skin. A silver halide optical fibre delivered the radiation emitted from the skin during resurfacing to an IR photonic detector. Time-dependent curves of the signals emitted from the skin layers were statistically evaluated and showed significant differences between the epidermis and the dermal layers. Similar results were obtained during in-vivo and ex-vivo measurements. The difference between the skin layers emission may be used for depth navigation during laser resurfacing.

Theoretical evaluation of a four-band fiber-optic radiometer.

A theoretical simulation of a four-band fiber-optic radiometric technique is presented. This is a technique for remote, noncontact temperature measurement of a sample near room temperature, under conditions of unknown emissivity and ambient temperature. A realistic setup of a broadband IR detector, a set of three filters, an IR fiber, and a MATLAB software package for the calculations, is simulated in two steps: a calibration process and a measurement process. The results of the simulation show the limitations and advantages of the four-band radiometric technique and show the expected resolution of the sample temperature and emissivity and of the ambient temperature measurement. The theoretical resolution of the sample temperature measured by the four-band radiometric setup comes close to the resolution achieved in an equivalent single-band radiometric setup. The four-band method has an additional advantage of making it possible to calculate values of emissivity and ambient temperature.

[Proxy decision in health questions and advance designations by patients. A practice-oriented review of the legal and ethical problems in treating the incompetent patient]. / Stellvertreterentscheidungen in Gesundheitsfragen und Vorausverfügungen von Patienten. Eine praxisorientierte Ubersicht zu rechtlichen und ethischen Problemen bei der Behandlung nicht einwilligungsfähiger Personen.

Except in emergencies, the medical treatment of incompetent patients also has to be based upon an informed consent between the physician and a legitimate legal representative (durable power of attorney). Consequently, the German 'Betreuungsrecht' advices persons to designate in advance such a proxy or surrogate. However, an additional court-decision is demanded, if a medical measure poses significant risks for the future health or the life of the incompetent patient. On the base of the available epidemiologic data we illustrate that neither our medical nor our legal system could realistically cope with the practical consequences of this legislation: The vast majority of our present decisions in such cases is not covered by a legally valid informed consent, which implies possible forensic consequences. This article provides relevant clinical and legal advice on how to protect the legitimate interests of all concerned within the present framework, which should urgently be revised.

Fiber-optic pulsed photothermal radiometry for fast surface-temperature measurements.

Temperature measurement based on pulsed photothermal radiometry is described. In this technique a body is irradiated by a laser pulse and its temperature is inferred from the shape of the emitted photothermal-signal curve. A prototypical system based on a pulsed CO(2) laser, an IR detector, and IR-transmitting silver halide optical fibers was constructed and used to evaluate the feasibility of this technique. An important feature of the technique is that changes in sample emissivity or geometric factors do not introduce errors in the temperature determination. Theory, simulation, and experimental results are given and discussed.

Single-mode mid-infrared silver halide planar waveguides.

A single-mode silver halide symmetric step-index planar waveguide for 10.6 microm is described. We fabricate the waveguide from extruded multimode silver halide fiber by pressing the fiber between metal plates while heating. The device is therefore automatically pigtailed to a fiber, which could ease the difficulties of coupling light into it. We achieved single-mode confinement by suitably adjusting the refractive index of the core and the cladding and by reducing the core thickness to 30 microm. The output radiation from the planar waveguide was measured to confirm single-mode confinement. Silver halide single-mode waveguides for the mid-infrared can be used to enhance sensitivity in fiber-optic evanescent-wave infrared spectroscopy measurements or for the development of mid-infrared single-mode lasers and interferometers.

A community hospital outbreak of legionellosis. Transmission by potable hot water.

Seven cases of nosocomial legionellosis occurred between February and September 1982 in a small community hospital in Upstate New York. All seven were cases of Legionella pneumophila serogroup 1; six were hospital patients and one a hospital employee. None of the cases died. During the peak of the outbreak, the incidence of nosocomial legionellosis was 1.2 cases per 100 patient discharges. An epidemiologic comparison of the six patient cases with 21 matched patient controls suggested that longer hospital stay (chi 1(2) = 24.2, p less than 0.001) and the proximity of patients' rooms to ward showers (chi 1(2) = 4.4, p less than 0.04) were significant risk factors for acquiring legionellosis. An environmental investigation demonstrated that the ward showers and the hospital hot water system were contaminated with L. pneumophila serogroup 1. Monoclonal antibody subtyping performed on isolates obtained during the outbreak investigation confirmed that the hot water system and patient isolates had an identical pattern of reactivity. The outbreak demonstrates that legionellosis can be a significant cause of nosocomial pneumonia in a community hospital and that transmission can occur from contaminated potable hot water sources, potentially via shower aerosols.