Unicameral bone cyst of the patella in a young dog.

This report describes a case of a solitary unicameral patellar bone cyst in a young dog. A five-month-old, male Dobermann Pinscher dog was referred for a 10-day left hindlimb lameness. A mild swelling of the peripatellar soft tissues of the left patella was detected upon physical examination. Signs of pain were elicited upon direct palpation of the patella. Radiographic examination revealed an oval radiolucency within the medullary cavity at the base of the left patella. Radiographic examination, arthroscopy, and histopathology findings supported the diagnosis of a benign patellar bone cyst. The condition was treated by surgical curettage and autogenous bone graft harvested from the ipsilateral proximal tibia. Clinical signs, including lameness and signs of pain upon deep palpation, disappeared three weeks after surgery. Follow-up re-evaluation five years after surgery revealed no recurrence of the cyst and the patient was asymptomatic.

Outcome following removal of TPLO implants with surgical site infection.

OBJECTIVE: To evaluate the outcome of surgical site infection (SSI) associated with tibial plateau levelling osteotomy (TPLO) implants following treatment by medical management alone or implant removal with or without the administration of antibiotic medication. ANIMALS: Ninety dogs (104 TPLO surgical procedures). METHODS: Records of dogs that had undergone TPLO implant removal due to SSI were reviewed. Outcome following treatment with antibiotic medications without implant removal, and treatment with implant removal with and without the administration of antibiotic medications was evaluated. RESULTS: Treatment of SSI with antibiotic medication alone failed in 88.9% (64/72) of the dogs. The clinical signs of SSI resolved in 94.9% (74/78) of the dogs treated with implant removal (with and without the administration of antibiotic medication post-implant removal). The effect of administration of antibiotic medication on outcome of treatment of the SSI by implant removal was not significant. The rate of SSI associated with the Synthes implant was higher than with the Slocum implant, but not the New Generation implant. CONCLUSION: Implant removal with or without the administration of antibiotic medication post-implant removal for treatment of TPLO SSI provided superior outcome compared to treatment with antibiotic medications without implant removal. CLINICAL SIGNIFICANCE: Implant removal should be considered for TPLO SSI that have not responded to appropriate medical management. Further investigation of the various TPLO implants and their effects on postoperative infection rate is warranted.

Extra-articular stabilization of the cranial cruciate deficient stifle with anchor systems.

Complete or partial rupture of the cranial cruciate ligament (CCL) is a common injury of the canine stifle. Most practicing veterinarians would agree that optimal outcome is best achieved with surgical intervention. A popular method of stabilization is an extra-articular suture stabilization. The objective of this manuscript is to describe suture placement in a more isometric position as compared to traditional suture placement. A second objective is to introduce the veterinary surgeon to novel anchor products used for stabilization.

Determination of isometric points for placement of a lateral suture in treatment of the cranial cruciate ligament deficient stifle.

Complete or partial rupture of the cranial cruciate ligament (CCL) is a common injury of the canine stifle. While numerous techniques have been developed for surgical treatment, extra-articular methods with placement of a lateral suture remain a popular treatment method. The purpose of this study was to determine the potential isometry of the six suture-paired sites; two on the femur and three on the tibia. In six femoro-tibial specimens with intact passive joint restraints, femoral sites adjacent to the proximal (F1) and distal (F2) poles of the fabella, and tibial sites adjacent to the patella insertion (T1), immediately cranial to (T2) and caudal to (T3) the long digital extensor tendon, were identified. A suture from one femoral site to one tibial site was placed under 0 or 5 N of preload, and tension was measured at joint angles of 150 degrees , 130 degrees , 90 degrees and 50 degrees . The F2-T3 combination was found to be most isometric. Isometry was re-assessed in the same specimens with the suture in the F2-T3 position, and under 5 N, 10 N and 15 N of preload, and after transection of the CCL. The suture pair retained its isometric pattern in the CCL transected specimens. There was no effect of preload on isometry patterns.

Relationship of the biceps-brachialis complex to the medial coronoid process of the canine ulna.

OBJECTIVE: To describe the anatomic relationship of the biceps brachii-brachialis muscle complex and the medial compartment of the canine elbow. STUDY DESIGN: Anatomical cadaveric study. METHODS: Cadaveric forelimbs, and radius and ulna bones were examined to study the anatomy of the biceps brachii-brachialis complex and its relationship to the medial compartment of the elbow. RESULTS: The biceps brachii and brachialis muscles comprise a large muscular complex. The biceps brachii is a pennate fibred muscle which plays a major role in stabilising the elbow joint during the stance phase and facilitating limb acceleration during the swing phase. Additionally, the insertion of the muscular complex onto the ulnar tuberosity is such that a moment is generated which the authors hypothesise rotates the medial coronoid process against the radial head. The result is a compressive force which generates internal shear stress oblique to the long axis of the medial coronoid process. The authors further hypothesise that this may result in the microdamage or fragmentation of the medial coronoid process. CONCLUSION: The authors' conclude that contraction of the biceps brachii and brachialis complex may explain an aetiopathogenesis for fragmented medial coronoid process not associated with elbow dysplasia.

Ilio-femoral external fixator application for temporary stabilization of recurring caudal ventral hip joint luxation after total hip replacement.

An ilio-femoral external fixator was applied to a 13-year-old male, castrated mixed breed dog with a caudal ventral luxation that persistently luxated following both closed reduction and open reduction with a total hip replacement. The external fixator was placed in order to temporarily maintain reduction during soft tissue healing. Upon removal of the external fixator the dog underwent physical therapy. Reduction was maintained and the dog returned to normal function.

Tibiotarsal arthroscopy. Applications and long-term outcome in dogs.

The objective of this retrospective article was to describe the use of, and to determine long-term outcome of, tibiotarsal arthroscopy in dogs. The medical records of 20 client-owned dogs with tibiotarsal joint disease with arthroscopic treatment were reviewed. Long-term follow-up evaluation of lameness, force plate gait analysis, and radiographs to assess progression of degenerative joint disease (DJD) were performed. Arthroscopy was utilized in the diagnosis of talar osteochondritis dissecans (OCD), collateral ligament injury, septic arthritis, immune mediated arthritis, and a distal talar fragment. Sixteen joints with OCD treated resulted in 10/14 dogs with lameness after exercise only, progression of DJD in most cases, and chronic lameness when comparing operated to unoperated limbs with force plate evaluation at a mean follow-up of 35 months. Following treatment, three dogs with collateral ligament injury had reduced weight bearing on the operated limb, radiographic progression of DJD, and minimal lameness at a mean follow-up of 27 months. Tibiotarsal arthroscopy can be successfully used to help diagnose, and often to treat: OCD, collateral ligament injury, fractures, septic and non-septic arthritis in the dog. The minimally invasive nature of arthroscopy preserved joint stability while allowing complete examination of the articular cartilage. In most cases long term tibiotarsal DJD advancement was the rule.

Aunties and Uncles Co-operative Family Project: the experiences of children, volunteers and parents.

BACKGROUND: This paper reports on the experiences of the children (nieces and nephews), volunteers (aunts and uncles) and parents involved in the Aunties and Uncles Co-operative Family Project in Sydney, Australia. The project has run for 30 years as an extended family network of community volunteers and has never been evaluated. METHODS: A survey comprising open-ended and closed questions relating to the service was administered to all stakeholders. Demographic data were collected on all respondents. The text from answers to open-ended questions on the survey was coded for similarities and differences and was categorized. From the categories, the experiences of children, volunteers and parents were written with exemplars from the respondents' text. RESULTS: Three major categories emerged from the text: enjoyment/satisfaction of the experience for volunteers, children and parents; family relationships; and the difference it has made to me (children, parents and volunteers). CONCLUSIONS: The long-term benefits of a supportive 'extended family type' relationship were recognized by all participants. Although the children were the primary focus of the project, parents and volunteers also described the rewards they experienced. The volunteer element was integral to providing the wide-ranging, ongoing supports which would not be possible from a paid staff basis.

Palliative care at home: stress for nurses in urban and rural New South Wales, Australia.

Nurses often experience positive and negative dimensions of caring for dying clients and their families. This project aimed to compare stress experienced by urban and rural community nurses working with palliative-care clients in the home. Participants included five nurses working in rural Australia and seven nurses working in an urban area. Transcribed data from unstructured audio-taped interviews were coded for common and contrasting themes, and a comparison was made of the stress experienced by the two groups of nurses. The major themes were role conflict and definition, family dynamics, time and workload. For both groups of nurses, the impact of family relationships and role conflict within the community impacted significantly to the stress they experienced. Debriefing opportunities for nurses to discuss stress, including educational and support sessions, is an essential component of best practice. Rural nurses had the additional stress of trying to provide a 24 h service over vast distances with a lack of financial resources.

Nurse researcher: always a researcher, sometimes a nurse.

A number of theoretical papers have highlighted the concept of the duality and dichotomy of roles when nurses are carrying out research in the clinical arena. The conflicts that can occur are between the roles of researcher and nurse and in the balance between research integrity and the welfare of the individual. There are various personal accounts in the literature of nurse researchers' experiences of unclear role expectations when doing research. There appears to be no consensus on how nurse researchers should handle these varying expectations. No comparative analysis of the reflections of a collective of nurse researchers on role expectations in different clinical contexts was found in an extensive literature search. This paper attempts to do this by analysing stories of a small group of nurse researchers in different clinical contexts. Data were analysed from written stories and audio-taped interviews with nurse researchers about moving from the researcher to the nurse role in doing clinical research. Thematic analysis indicated that the participants' reactions could be classified as either those of a nurse researcher, always the researcher, or as the nurse researcher, sometimes the nurse. There were no distinct differences in relation to research topic, methodology or context. The study highlights the fact that nurses need better research education, team and management support when conducting research and opportunities to debrief after encountering mixed role expectations in the field. Open debate amongst nurse researchers about role delineation is essential to both novices and experts for them to share their experiences and their solutions.

Stories about breast cancer in Australian women's magazines: information sources for risk, early detection and treatment.

Sixty articles in five Australian women's magazines were analyzed for journalistic qualities, metaphors, narrative features and accuracy of clinical facts related to risk, early detection and treatment of breast cancer. The stories were features, news features or soft news stories. The stories reflected the 'good news' editorial style of women's magazines. A dominant theme in the stories was that early detection of breast cancer is crucial and equals survival. While there were few inaccuracies in the stories, there was little detail of treatment modalities, an emphasis on lifestyle as a risk factor and a prevailing message that a genetic history of breast cancer means you will get it. A major implication of the findings is that nurses, who provide information to women, must be aware of the goals of journalists and the educational power of narrative logic of stories in women's magazines.

Malignant wound management: what dressings do nurses use?

This paper reports on the findings from the first part of a three-phase project that aimed to identify nursing strategies used in the management of malignant wounds. The difficulties relating to the management of these wounds and the significant physical and psychological impact on patients are described. A quantitative postal survey aiming to identify the types of dressing used in the care of malignant wounds was sent to specialist nurses working in oncology and palliative care in New South Wales, Australia. Additional qualitative data showed that the major issues were coping with odour and meeting the financial costs of the dressing products. The long list of products compiled for this research demonstrates the complexities nurses face when selecting dressings for the management of malignant wounds. Furthermore, there are no clear recommendations to guide nursing practice. This study provides a framework for subsequent phases of the project and will hopefully lead to the development of guidelines for best practice in malignant wound management.

A client-centered model: discharge planning in Juvenile Justice Centres in New South Wales, Australia.

Health care delivered in Juvenile Justice Centres in New South Wales, Australia, leads to improvement in the health status of detainees while in custody but this declines on discharge and is contributed to by a breakdown in continuity of care. In an effort to halt this decline in health status, a model of interdisciplinary discharge planning is proposed to address the interface between Juvenile Justice Centres and adult correctional facilities and the community. Key features of the process are: collaboration through the development of links by establishment of a community liaison co-ordinator position; open and continuous communication between service providers; continuous involvement of detainees and their significant others; and ongoing support to detainees once discharged. Evaluation of the discharge-planning process ensures that the process is appropriate to meet the needs of this specific and diverse population of young people and supplies feedback to all service providers. The trusting relationship that is developed between detainees and registered nurses within centres leaves nurses ideally placed to co-ordinate the discharge-planning process.

Locked up: researching in an unfamiliar environment.

This paper describes the personal experiences of three nurse researchers who entered a new field, one they would not normally encounter. The experiences occurred during a research project involving detainees in Juvenile Justice Centres in New South Wales, Australia. The Healthy Lifestyle Check computerized health screening program was used to seek responses regarding the detainees' health behaviours, knowledge of health services and health education needs. Physical assessment was conducted and counselling and referral was provided. The researchers' best endeavours to prepare for the field were not enough for the reality of the controlled environment, fears for personal safety and the stamina required to complete the project. The researchers' completion of the project enriched their professional lives with a sense of achievement and a new confidence in their ability to work in uncharted fields. Implications for future nursing research that incorporates fieldwork in this environment include: (i) ensuring adequate knowledge of security protocols; (ii) securing access to participants; and (iii) ensuring adequate physical assistance for fieldworkers to enter.

Supportive care for women with breast cancer: Australian nurses' perspective.

A research project was undertaken to describe how the support needs of women who have had treatment for breast cancer were being met in New South Wales, Australia. Data were collected from both the women and the nurses who cared for them. The findings from the first part of the study examined the nurses' perceptions of the women's needs and how they as health professionals, fulfilled these needs. Analysis was both qualitative and quantitative. Seventy-eight nurses responded to a questionnaire and 15 were interviewed. The findings indicated that the nurses perceived information on disease process and physical aspects of the disease as essential to supporting the women with breast cancer. While they saw providing emotional support to the women as important the nurses themselves often lacked the time and skills to provide it.

Osteochondrosis of the canine tibiotarsal joint.

This article reviews previous literature and current conclusions regarding osteochondrosis dissecans in the canine tarsus since it was first reported only 20 years ago. Breed, signalment, and clinical characteristics can greatly aid the clinician in suspicion of this condition. Specific radiographic techniques for confirmation of osteochondrosis are discussed. Treatment options, expectations, and specific surgical approaches are reviewed.

Healthy Lifestyle Check. A computerized health screening program.

The Healthy Lifestyle Check program is a computerized tool used to survey current health status and risk factors for potential ill health as well as to promote a healthy lifestyle. The program is an innovative teaching tool for student nurses, facilitating the integration of practice, education, and research. The program required self-report answers to questions relating to health history and current health-related behaviors with results of cholesterol, blood pressure, height, and weight assessment. Feedback to participants was provided by use of on-screen displays and printed reports containing public health messages, as well as counseling by the nurses. Results indicated that participants had not been screened for testicular, prostatic, and cervical cancers, or breast self-examination and medical checkups, and that they indulged in high levels of risk-taking behaviors such as high levels of alcohol consumption and low levels of exercise. The Healthy Lifestyle Check program is a valuable research tool that collects data and provides health information to participants, and has been used to teach nursing students the application of education and research to nursing practice.

Enteroplication for the prevention of intussusception recurrence in dogs: 31 cases (1978-1992).

Medical records of 31 dogs that had undergone surgery for correction of intussusception during a 14-year period were reviewed. Enteroplication was performed on 9 dogs during the initial surgery, and intussusception did not recur in any of these dogs. Intussusceptions recurred in 6 of 22 dogs without enteroplication. Five of these dogs had undergone resection of the primary lesion and anastomosis and 1 dog had undergone manual reduction of the intussusception. Intussusceptions recurred proximal to the initial lesion in 4 dogs, and at the same site in 2 dogs. Enteroplication was performed in 4 dogs following surgical correction of recurrence of an intussusception, and further recurrences were not seen in any of these dogs. Enteroplication did not cause any apparent adverse effects and decreased the probability of recurrence of intussusception in these dogs.

Evaluation of polysulfated glycosaminoglycan for the treatment of hip dysplasia in dogs.

A double-blinded, controlled clinical study was performed to compare the response of adult dogs affected with hip dysplasia to a placebo and three different dosages of polysulfated glycosaminoglycan (PSGAG): 2.2 mg/kg, 4.4 mg/kg, and 8.8 mg/kg. Dogs were randomly assigned to treatment groups. The drug was administered intramuscularly every 3 to 5 days for a total of eight injections. Response to treatment was analyzed based on changes in lameness, range of motion (ROM), and pain on manipulation of the hip joints. Evaluation for adverse reactions included complete blood cell (CBC) count, blood urea nitrogen (BUN), creatinine, and physical examination. Data were collected on a total of 111 dogs. Eighty-four met all criteria for inclusion in the study. Dogs that were given 4.4 mg/kg of PSGAG showed the greatest improvement in orthopedic scores, whereas dogs in the placebo group showed the smallest improvement; however, the differences in clinical improvement between the four treatment groups were not statistically significant. No local or systemic adverse reactions related to the drug were observed.