Ultrasonographic examination of injuries to the achilles tendon in dogs and cats.

The value of ultrasonography in the diagnosis of lesions of the Achilles tendon was Investigated in 42 dogs and seven cats. A standardised four-part ultrasonographic examination was established. Linear transducers with a frequency of more than 7.5 MHz were used. Ultrasonography allowed identification and differentiation of total ruptures and the differentiation of partial ruptures into deep or superficial ruptures, or those comprising muscular tears. The healing process could be monitored and imaged using this technique. Suture material was readily visible in surgically treated cases. Displacement of the superficial digital flexor tendon could be identified. In such cases, the tendon tissue was seen either medially or laterally to the calcaneus. The healing process of the Achilles tendon could also be documented using ultrasonography. However, it was not possible to determine the age of the injury and the exact end of the healing process. Ultrasonography therefore proved to be an excellent diagnostic method for imaging lesions of the Achilles tendon and associated injuries in dogs and cats. After physical examination, the technique should be the next logical step in the evaluation of a suspected injury to the Achilles tendon.

Ultrasonography for the diagnosis of diseases of the tendon and tendon sheath of the biceps brachii muscle.

OBJECTIVE: To describe the ultrasonographic appearance of the normal and diseased biceps brachii tendon and its tendon sheath in dogs. STUDY DESIGN: A prospective clinical study. ANIMALS: One hundred twenty client-owned dogs. METHODS: In the first part of the study, the ultrasonographic appearance of the normal biceps brachii muscle and the surrounding soft tissue was determined in 27 healthy dogs. Standard views were described and established. In the second part, 120 dogs with suspected pathology of the biceps brachii muscle were examined ultrasonographically. Fifty-five of these dogs had no sonographic changes, and 65 dogs had sonographically detectable pathologic changes of the tendon or the tendon sheath or both. The mean age of the affected dogs was 3.7 years. The ratio of males to females was 1.95:1. Sedation or anesthesia of the dogs was required because of the extreme movements of the leg necessary for the examination. To achieve a perpendicular view of the tendon and the tendon sheath, the area of the shoulder joint was rotated outward and abducted as far as possible. Examination of the muscle-tendon apparatus of the biceps brachii muscle was divided into 4 main sections. RESULTS: Linear transducers (7.5-10 MHz) allowed the soft tissue structures to be easily visualized with ultrasonography. Pathologic changes of the tendon and tendon sheath were visualized sonographically by using high-frequency linear probes. Partial or complete tendon rupture, medial luxation of the tendon, corpora libera in the tendon sheath, and tenosynovitis were clearly shown. CONCLUSIONS: High-frequency ultrasonography using linear transducers allows the examiner to accurately define the pathologic changes in the region of the biceps brachii tendon in dogs. CLINICAL RELEVANCE: The use of sonography for diagnosis of disease processes of the tendon and tendon sheath of the biceps brachii muscle complements clinical and radiographic examination findings.

Sonography of the canine stifle.

When diagnosing disease of the stifle in dogs ultrasonography is a good addition to clinical and radiological examination. Radiology can evaluate the bony aspects of the joint and their relationship to each other. In contrast, sonography allows visualization of the soft tissue. For most evaluations the 7.5 MHz linear scanner is suited best. Normal stifles of 58 dogs of different breeds were evaluated using a standardized examination procedure. This procedure had been derived from that used in humans. The stifle is divided into several regions which are examined and evaluated. These are the suprapatellar, infrapatellar, lateral, caudal and medial region. One hundred twenty seven patients which had problems associated with the stifle joint were examined sonographically after a clinical and radiographic exam. Osteochondrosis dissecans, ruptured cranial cruciate ligament, meniscal damage, arthritis, tumor, post surgical conditions, injuries of the patella, patellar ligament or tibial tuberosity and luxating patella were examined sonographically and the findings recorded.

[Sevoflurane (SEVOrane) as an inhalation anesthetic in dogs in comparison with halothane and isoflurane]. / Sevofluran (SEVOrane) zur Inhalationsanästhesie beim Hund im Vergleich mit Halothan und Isofluran.

1969 Sevofluran was synthesized and in December 1995 licensed for clinical use in Germany. The low blood/gas partition coefficient is responsible for the fast uptake and elimination of sevoflurane. Sevoflurane does not irritate the airway. In human medicine no side effect of liver- and kidney function have been seen after sevofluran anaesthesia. There is low cardiovascular and respiratory depression caused by sevoflurane. In this study the use of sevoflurane in dogs should be tested and compared with isoflurane and halothane anaesthesia. All dogs were premedicated with /-methadon and diazepam. No significant depression of the cardiovascular system was seen. Neither kidney-nor hepatotoxic side effects could be found after sevoflurane, isoflurane and halothane anaesthesia. After sevoflurane anaesthesia the dogs woke up quietly and without any excitation and were able to stand on average ten minutes earlier after sevoflurane anaesthesia than after isoflurane and 85 minutes earlier than after halothane anaesthesia.

[Diseases of the Achilles tendon in dogs and cats]. / Achillessehnenerkrankungen bei Hund und Katze.

Dogs and cats rarely have problems with the Achilles tendon and if so, it usually results from a direct trauma. Prime area for injuries is the insertion on the tuber calcanei or directly proximal. One defers between complete and partial ruptures, acute and chronic injuries as well as displacement of the tendon of the superficial digital flexor muscle. In 38 cases (33 dogs and five cats) the clinical examination, radiology, ultrasonography and therapy are shown. Usually the clinical examination is sufficient for a diagnosis (hyperflexion of the hock and weight-bearing on the plantar surface of the metatarsus). The radiology primarily shows up abnormalities on the calcaneus, mineralisations of the tendon and allows the assessment of implants. Ultrasonography is the diagnostic imaging of choice for judgement of tendon diseases as well as the progress of their healing. Tendon suture is advisable if the rupture is open, fresh and/or complete and in cases of luxation of the superficial digital flexor muscle. Immobilisation of the tarsus in hyperextension seems to be of utmost importance no matter if an operative or conservative therapy is chosen.

[Excision arthroplasty of the hip joint in dogs and cats. Long-term results of the veterinary surgery clinic at the Justus Liebig University of Giessen]. / Resektionsarthroplastik des Hüftgelenkes bei Hunden und Katzen. Ergebnisse einer Langzeitstudie an der Chirurgischen Veterinärklinik der Justus-Liebig-Universität Giessen.

Since the introduction of excision arthoplasty in veterinary medicine the question of indication is often asked. The maximum of the patient's body weight up to which surgery should be performed is another discussed problem. A long-term study from January 1985 to July 1995 at the Veterinary Surgery Department at the Justus-Liebig-University was carried out to answer these questions (222 patients, 155 dogs and 67 cats). Trauma and Legg-Calvé-Perthes disease came first in the list of indications. In case of postoperative problems trouble with lameness after high activity, long rest or at the time of change in weather could be seen. No owner of an animal thought that the life quality of his animal was restricted by this occasional problems. At a body weight over 30 kg the occasional problems were more often seen but every patient had less clinical problems after surgery than before. In this group no deterioration was seen.

Sonography of the musculoskeletal system in dogs and cats.

Sonography of the musculoskeletal system in dogs and cats was undertaken to evaluate the application of this imaging procedure in orthopedics. In most of the patients a 7.5 MHz linear transducer was used because of its flat application surface and its resolving power. The evaluation of bone by sonography is limited, but sonography can provide addition information regarding the bone surface and surrounding soft tissue. Ultrasound is valuable for assessing joint disease. Joint effusion, thickening of the joint capsule and cartilage defects can be identified sonographically. It is also possible to detect bone destruction. Instabilities are often identified with the help of a dynamic examination. Soft tissue abnormalities of the musculoskeletal system lend themselves to sonographic evaluation. Partial or complete muscles or tendon tears are able to be differentiated and the healing process can be monitored. Most of the diseases that are in the area of the biceps or the achilles tendon, such as dislocation of the tendon, old injuries with scarification, free dissecates in the tendonsheath, tendinitis and/or tendosynovitis can be differentiated by sonography. In addition, with clinical and laboratory findings, it is often possible to make a correct diagnosis with ultrasound in patients with abscesses, foreign bodies, hematomas, soft tissue tumors and lipomas.

[Incidence of severe hypoglycemia in relation to metabolic control and patient knowledge]. / Inzidenz schwerer Hypoglykämien in Abhängigkeit von der Stoffwechselqualität und dem Patientenwissen.

BACKGROUND: The question whether the incidence of severe episodes of hypoglycaemia in type I and type II diabetics correlates with the level of the patient's knowledge about hypoglycaemia and the quality of metabolic control. PATIENTS AND METHODS: A total of 234 consecutive type I diabetics (age and diabetes duration 48 and 16 years, respectively; blood glucose, self-monitored 63%) and 237 type II diabetics treated with glibenclamide (mean dose 6.7 mg/day) (age and diabetes duration 65 and 9 years, respectively; glucosuria, self-monitored 36%) who attended the Berlin outpatient diabetic centre were investigated. RESULTS: Of the type I diabetics 23 (9.8%) experienced a total of 32 severe episodes of hypoglycaemia (incidence 0.14 per patient/year). Patients at risk of experiencing hypoglycaemia were about 20 years younger, injected insulin more often (3.8 vs 2.3 injections/day; p < 0.01) and had a lower HbA1 level (7.8% vs 9.0%; p < 0.01) than those having no hypoglycaemic reactions. Ten of the 23 diabetics suffering severe episodes of hypoglycaemia showed signs of kidney disease. The most common causes of hypoglycaemia were dietary errors (18.7%) or incorrect doses of insulin (12.5%), alcohol consumption (12.5%) and unusual physical exertion (23%). In terms of their knowledge about hypoglycaemia, there were no notably differences between patients with and those without hypoglycaemic reactions. Among the 237 type II diabetics treated with glibenclamide, three (1.3%) experienced one episode of severe hypoglycaemia each (incidence: 0.013 patient/year). Old age, maximum dosage of glibenclamide (15 mg/day) and multimorbidity were characteristic of these patients. Enquiries showed that only 49% (n = 160) of all type II diabetes had adequate knowledge about hypoglycaemia. CONCLUSION: In type I diabetics, there appears to be no relationship between the hypoglycaemia risk and the patient's theoretical knowledge of hypoglycaemia. In future, apart from theoretical knowledge, more attention must be paid to practical training to improve awareness of hypoglycaemia. Educational programs for type II diabetics must attach more weight to the problem of hypoglycaemia.

[The effect of blood pressure-reducing therapy with captopril on tubular marker excretion in type-1 diabetics with nephropathy]. / Einfluss einer blutdrucksenkenden Therapie mit Captopril auf die Exkretion tubulärer Marker bei Typ-I-Diabetikern mit Nephropathie.

A prospective open clinical trial was carried out with 23 hypertensive type I diabetics (13 men, ten women, mean age 49 +/- 9.1 years, duration of diabetes 18 +/- 9.1 years) with early nephropathy. Glomerular and tubular renal function and metabolic parameters were monitored during 8 months' treatment with the angiotensin converting enzyme (ACE) inhibitor, captopril, in addition to previous antihypertensive treatment with one or more drugs. Blood pressure control tended to improve on captopril (systolic pressures 152 +/- 13 vs 140 +/- 13 mm Hg, P < 0.05; diastolic pressures 89 +/- 10 vs 87 +/- 10 mm Hg, not significant). Proteinuria (> 0.5 g/24 hours) fell into the microalbuminuria range (albumin excretion 2-20 mg/mmol creatinine) in four out of 13 patients, and microalbuminuria disappeared in four out of ten patients. Urinary levels of the brush border enzyme N-acetyl-beta-D-glucosaminidase (NAG), a marker of tubular dysfunction, were initially raised and fell significantly after 8 months' treatment with captopril (20.3 +/- 14.4 vs 8.8 +/- 8.1 U/g creatinine; P < 0.01). Captopril did not affect metabolic control (HbA1, total, HDL and LDL cholesterol, triglycerides, apolipoproteins A1 and B) or the insulin dosage. These results show that long-term treatment with captopril may favourably influence both albumin excretion and NAG activity, a marker of tubular dysfunction, in type I diabetics with nephropathy.

Improvement of metabolic control and changes of fatty acid composition do not alter platelet aggregability and thromboxane production in type 2 diabetes mellitus.

To evaluate whether improvement of metabolic control or changes in fatty acid composition of serum lipids may alter thromboxane (TXB2) formation and platelet function we followed up 25 newly diagnosed type 2 diabetics without angiopathy for about 6 months. Improvement of metabolic control was associated with significant decrease in total cholesterol (C), HDL-C, LDL-C, triglycerides (TG) and ratios of total C/HDL-C and LDL-C/HDL-C, respectively. Palmitic acid of TG and phospholipids decreased significantly whereas linoleic acid increased in the two serum lipids. The ADP-induced platelet aggregability and sensitivity were not altered. There was even no effect on TXB2 synthesis capacity of clotting whole blood during 6 months of treatment. Platelet aggregability and TXB2 formation were not correlated to the degree of metabolic control, nor was there any correlation to serum lipids and their fatty acid composition.

[Bilateral ectopic ureter in a Persian cat--a possible cause of urinary incontinence]. / Bilateral ektopischer Ureter bei einem Perserkater--eine mögliche Ursache der Harninkontinenz.

A bilateral congenital dislocation of the ureter in a one year old male Persian cat is discussed. Diagnostic procedures, operative implantation of both ureters into the bladder, postoperative course and therapy are described.

Thromboxane production and platelet aggregation in type 2 diabetes mellitus without vascular complications.

Diabetic individuals frequently have platelet hyperaggregability and increased thromboxane (TXB2) production. To evaluate whether improvement of metabolic control or changes in fatty acid composition of serum lipids might alter thromboxane (TXB2) formation and platelet function, we followed up 25 newly diagnosed type 2 diabetics without angiopathy for about 6 months. Improvement of metabolic control (HbA1, fell from 12.0 +/- 0.3 to 9.0 +/- 0.3%; p less than 0.01) was associated with significant decrease in total cholesterol, triglycerides, and ratios of total cholesterol/HDL-cholesterol and LDL-cholesterol/HDL-cholesterol. Palmitic acid of phospholipids decreased significantly, whereas eicosapentaenoic acid increased. Regardless of this, the ADP-induced platelet aggregability and sensitivity were not altered. There was no effect whatever on the TXB2 synthesis capacity of clotting whole blood (204.9 +/- 25.0 vs 222.8 +/- 32.0 ng/ml) over 6 months of treatment. Platelet aggregability and TXB2 formation were not correlated to the degree of metabolic control, nor were there any correlations to serum lipids and their fatty acid composition. Thus, we are tempted to speculate that glucose metabolism in diabetes itself does not affect platelet aggregation or TXB2 formation in type 2 diabetes mellitus.

Prevalence of peripheral and autonomic neuropathy in newly diagnosed type II (noninsulin-dependent) diabetes.

Type II (noninsulin-dependent) diabetes (NIDDM) can be preceded by a relatively long period of disturbed glucose metabolism. Therefore, the prevalence of neuropathy and its possible relationship to metabolic abnormalities were investigated in 95 newly diagnosed type II diabetics (upper age limit was set at 55 years) with a mean age of 49.7 years (men/women ratio 1:1). The study program was as follows: Detailed history, clinical investigation of peripheral nerves, sensory assessment to touch and pain (pinprick), vibration sensation using established techniques, and motor nerve conduction velocities (MNCV) of the fibular (peroneal) and ulnar nerves. Three cardiovascular autonomic function tests were performed: the Valsalva maneuver, standing (ratio between RR-intervalmax: RR-intervalmin), and deep breathing (maximum/minimum heart rate). Vascular diseases were diagnosed using a conventional 12-lead resting electrocardiogram (ECG) and impedance measurement of the lower extremities. The results were as follows: abnormal vibration sensation in 80.0%, abnormalities of MNCV in 15.7%, abnormal sensations to touch or pinprick in 14.7%, and loss of reflexes in 13.6%. If peripheral neuropathy was defined as having at least three of the four abnormalities plus neuropathic symptoms, the prevalence was 6.3% (6 of 95 patients). Abnormalities of the three cardiovascular autonomic function tests were much less prevalent in type II diabetic patients (2.1-7.3%). In conclusion, the study showed that peripheral and autonomic neuropathy is not common at diagnosis in middle-aged type II diabetic patients without signs of microvascular or macrovascular complications.

[Quality control of blood glucose self-monitoring using the Glucosignal test strip and Haemo-Glucotest 20-800]. / Qualitätskontrolle von Blutzuckerselbstmessungen mittels der Teststreifen Glucosignal und Haemo-Glucotest 20-800.

In 157 capillary blood samples of type I diabetics parallel determinations of the blood sugar concentration were performed by means of the visual evaluation of the test strips Glucosignal and Haemo-Glucotest 20-800 in comparison to an enzymatic reference method by trained special personnel. On the basis of the correlation coefficients the two test strips showed a good accordance between visual evaluation and the reference method (r = 0.98 and 0.97, respectively). In comparison to the reference method in Glucosignal there is a tendency to underestimation (-0.67 mmol/l), on the other hand in the Haemo-Glucotest 20-800 the blood glucose concentrations are on an average +0.87 mmol/l above the reference value. In visual valuation of the blood glucose concentrations by means of Haemo-Glucotest 20-800 with increasing blood glucose concentration an increasing inexactness is to be stated, whereas Glucosignal is characterized by more favourable parameters of quality.

[Concentration of thiobarbituric acid-reactive substances (TBARS) in the plasma of patients with atherosclerosis with different localizations and different degrees of severity]. / Konzentration Thiobarbitursäure-reaktiver Substanzen (TBARS) im Plasma von Patienten mit Atherosklerose unterschiedlicher Lokalisation und unterschiedlichen Schweregrades.

The concentration of thiobarbituric acid reactive substances (TBARS) formed as a result of lipid peroxidation and prostanoid metabolism was measured in the plasma of patients with coronary or peripheric atherosclerosis. From the results conclusions were deduced to the function of reactive O2-species in the atherogenesis. We found in plasma of patients with coronary as well as with peripheric atherosclerosis increased TBARS concentrations dependent on the dimension of atherosclerosis as an index of activation of reactive O2-species formation. The TBARS concentration correlated with the cholesterol and LDL-cholesterol concentration in plasma.

Further evidence for tubular dysfunction in insulin dependent diabetes.

There is evidence that increased excretion of urinary enzymes and low-molecular mass proteins indicate impaired tubular function. The excretion of N-acetyl-beta-D-glucosaminidase (NAG), lysozyme, and ribonuclease in Type I diabetic patients with (n = 19) and without (n = 17) persistent proteinuria (urinary protein excretion greater than 0.5 g/day) was investigated and compared with this excretion in 30 weight- and gender-matched nondiabetic subjects without renal disease. Urinary NAG excretion was significantly higher in diabetic patients with and without persistent proteinuria (1.16 +/- 0.09 and 3.19 +/- 1.2 Umol/L creatinine, respectively) compared to controls (0.37 +/- 0.03 Umol/L creatinine p less than 0.01). In addition, the urinary excretion of lysozyme and ribonuclease was significantly increased in diabetic patients. Urinary NAG was found to correlate positively with albuminuria and proteinuria (r = 0.95 and 0.93, respectively), as well as with ribonuclease and lysozyme (r = 0.93 and 0.60; p less than 0.01) in patients with persistent proteinuria. Furthermore, NAG excretion was significantly related to the duration of diabetes (r = 0.36; p less than 0.05). No relationship existed between urinary NAG and serum creatinine, beta-2-microglobulin, and degree of metabolic control (HbA7). The lysozyme excretion, but not NAG excretion, was significantly related to hypertension in patients with clinical proteinuria. In conclusion, our results suggest a relationship between the development of tubular dysfunction and the impairment of glomerular function in diabetic nephropathy. An increased excretion of NAG and low-molecular mass proteins may indicate early nephropathy