Tolerability and outcome of palliative treatment for metastatic pulmonary carcinoma in cats.

OBJECTIVES: Pulmonary carcinoma is uncommon in cats and reporting of outcomes following medical treatment is limited, especially in presence of metastases. The aim of this study was to describe the outcome of cats affected by metastatic primary pulmonary carcinoma and to evaluate the tolerability of palliative treatment in this patient population. MATERIALS AND METHODS: Medical records were searched for cats with a cytological or histopathological diagnosis of primary pulmonary carcinoma and evidence of metastatic disease. Cats were treated with antineoplastic agents, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs) or received no systemic treatment. Cases in which thoracic CT was not performed, and those lacking definitive diagnosis by cytology or histopathology or receiving curative-intent surgery were excluded. RESULTS: Thirty-four cats were identified: 18 were treated with antineoplastic agents and 16 received corticosteroids, NSAIDs or no treatment. Presenting clinical signs included coughing (53%), tachypnoea (26%), gastrointestinal signs (35%) and lethargy (18%). CT scan identified metastases to the lung parenchyma in all cases and additional metastatic lesions in 10 of 34 (59%) cases; pleural effusion was detected in 11 cases (32%). The overall median survival time for all cats was 64 days [range 1-1352 days; 95% confidence interval (CI) 48-164]. Presence of respiratory signs at presentation was the only factor influencing survival in the multivariable analysis. CLINICAL SIGNIFICANCE: Medical treatment was well tolerated and appeared to palliate clinical signs in cats with metastatic pulmonary carcinoma, albeit with a modest duration and short overall survival. The role and benefit of chemotherapy/antineoplastic agents versus conventional palliative drugs in this setting remains unclear.

BCL2 and MYC are expressed at high levels in canine diffuse large B-cell lymphoma but are not predictive for outcome in dogs treated with CHOP chemotherapy.

Diffuse large B-cell lymphoma (DLBCL) is the most common haematopoietic malignancy in dogs. Recently, MYC and BCL2 expression levels determined with immunohistochemistry (IHC) were found to be prognostic in people with DLBCL. We hypothesized that canine DLBCL can be similarly subdivided into prognostic subtypes based on expression of MYC and BCL2. Cases of canine DLBCL treated with CHOP chemotherapy were retrospectively collected and 43 dogs had available histologic tissue and complete clinical follow-up. Median values of percent immunoreactive versus immunonegative cells were used to determine positive or negative expression status. Completion of CHOP was significantly associated with a positive outcome. Compared with human patients, our canine DLBCL patients had high IHC expression of both MYC and BCL2, and relative expression levels of one or both markers were not associated with clinical outcome.

Horizontal nystagmus and multiple sclerosis using 3-Tesla magnetic resonance imaging.

BACKGROUND: Nystagmus in patients with multiple sclerosis (MS) is generally attributed to brainstem disease. Lesions in other regions may result in nystagmus. The identification of these other sites is enhanced by using 3-Tesla magnetic resonance imaging (3TMRI) due to increased signal-to-noise ratio. OBJECTIVE: We sought to evaluate the distribution of structural lesions and disruption of tracts in patients with horizontal nystagmus secondary to MS using 3TMRI. METHODS: Twenty-four patients (20 women, 4 men; age range 26-55 years) with horizontal nystagmus secondary to MS underwent 3TMRI brain scans; and 18 patients had diffusion tensor imaging (DTI) for tractography. RESULTS: Nystagmus was bidirectional in 11, right-sided in 6 and left-sided in 7. We identified 194 lesions in 20 regions within the neural integrator circuit in 24 patients; 140 were within the cortex and 54 were within the brainstem. Only two patients had no lesions in the cortex, and 9 had no lesions in the brainstem. There was no relationship between side of lesion and direction of nystagmus. Thirteen of 18 (72 %) had tract disruption with fractional anisotropy (FA) values below 0.2. FA was significantly lower in bidirectional compared to unidirectional nystagmus (p = 0.006). CONCLUSION: In MS patients with horizontal nystagmus, lesions in all cortical eye fields and their descending connections were evident. Technical improvements in tractography may help identify the specific site(s) resulting in nystagmus in MS.

Lymphangiosarcoma in 12 dogs: a case series (1998-2013).

Lymphangiosarcoma (LAS) is an uncommon malignant neoplasia arising from lymphatic endothelium; little information exists regarding therapy. Single institutional retrospective review for canine LAS histopathology diagnoses over a 15-year period yielded 12 dogs. Ten dogs were presented for a mass and/or swelling at cervical, trunk or limb regions. Prior to diagnosis, 10 dogs received empiric wound therapy. Cytology performed in 10 consisted of mild inflammation. Survival ranged from 60, 168 and 876 days for three dogs with palliation; 90 days with prednisone in one; 182 days with chemotherapy in one; 240, 267, 487, 630 and 941 days for five receiving surgery; and 574 days for one receiving surgery, radiation and chemotherapy. One dog is alive with recurrence at 243 days following surgery and carboplatin chemotherapy. Clinical improvement existed in LAS dogs receiving multimodal therapies. Early tissue biopsies are recommended for progressive oedematous lesions of unknown origin.

Differences in regional bone metabolism at the spine and hip: a quantitative study using (18)F-fluoride positron emission tomography.

SUMMARY: This study showed that regional bone blood flow and (18)F-fluoride bone plasma clearance measured by positron emission tomography are three times lower at the hip than the lumbar spine. INTRODUCTION: Measurements of effective bone plasma flow (K (1)), bone plasma clearance (K ( i )) and standardised uptake values (SUV) using (18)F-fluoride positron emission tomography ((18)F-PET) provide a useful means of studying regional bone metabolism at different sites in the skeleton. This study compares the regional (18)F-fluoride kinetics and SUV at the hip and lumbar spine (LS). METHODS: Twelve healthy postmenopausal women with no history of metabolic bone disease apart from two with untreated osteoporosis were recruited. Each subject underwent 60-min dynamic (18)F-PET scans at the LS and proximal femur two weeks apart. K (1), K ( i ) and SUV were measured at the LS (mean of L(1)-L(4)), femoral neck (FN), total hip (TH) and femoral shaft (FS). Differences between sites were assessed using the nonparametric Kruskal-Wallis test with a Bonferroni correction for multiple comparisons. RESULTS: Values of K (1), K ( i ) and SUV at the FN, TH and FS were three times lower than at the LS (p = 0.003). Amongst the proximal femur sites, K ( i ) and SUV were lower at the FS compared with the FN and TH, and SUV was lower at the TH compared with the FN (all p < 0.05). The volume of distribution was lower at the TH and FS compared with the LS (p < 0.05). CONCLUSION: The lower values of K (1), K ( i ) and SUV at the hip suggest that lower bone blood flow in the proximal femur is an important factor explaining the principal reason for the differences in bone fluoride kinetics between the LS and hip sites.

Vascular-targeted photodynamic therapy with BF2-chelated Tetraaryl-Azadipyrromethene agents: a multi-modality molecular imaging approach to therapeutic assessment.

BACKGROUND: Photodynamic therapy (PDT) is a treatment modality for a range of diseases including cancer. The BF(2)-chelated tetraaryl-azadipyrromethenes (ADPMs) are an emerging class of non-porphyrin PDT agent, which have previously shown excellent photochemical and photophysical properties for therapeutic application. Herein, in vivo efficacy and mechanism of action studies have been completed for the lead agent, ADMP06. METHODS: A multi-modality imaging approach was employed to assess efficacy of treatment, as well as probe the mechanism of action of ADPM06-mediated PDT. RESULTS: Tumour ablation in 71% of animals bearing mammary tumours was achieved after delivery of 2 mg kg(-1) of ADPM06 followed immediately by light irradiation with 150 J cm(-2). The inherent fluorescence of ADPM06 was utilised to monitor organ biodistribution patterns, with fluorescence reaching baseline levels in all organs within 24 h. Mechanism of action studies were carried out using dynamic positron emission tomography and magnetic resonance imaging techniques, which, when taken together, indicated a decrease in tumour vascular perfusion and concomitant reduction in tumour metabolism over time after treatment. CONCLUSION: The encouraging treatment responses in vivo and vascular-targeting mechanism of action continue to indicate therapeutic benefit for this new class of photosensitiser.

FDG-PET as a "metabolic biopsy" tool in non-lung lesions with indeterminate biopsy.

The differentiation of benign versus malignant disease in a lesion identified on conventional imaging is a commonly encountered problem. Attempted biopsy is often unsuccessful or falsely reassuring and may lead to the patient being sent for more invasive and potentially morbid investigations. Having previously identified the value of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) in this circumstance in patients with lung lesions, our current aim was to investigate the role of FDG-PET in helping to identify more accurately those patients with malignant lesions outside the lung. FDG-PET scanning was performed in 50 patients; most had undergone unsuccessful biopsy of a lesion outside the lung, while in a smaller number no attempt at biopsy had been made as it had been considered too dangerous. Follow-up was by histology or, if this was unavailable, by clinical progress to death or a minimum of 12 months post scan. Visual and quantitative analysis was performed. On visual analysis, the positive and negative predictive values were 89% and 100%, respectively. On quantitative (SUV>2.5) analysis, positive and negative predictive values were 93% and 86%, respectively. A negative FDG-PET study in these circumstances virtually excludes malignancy and allows the patient to be reassured. A positive scan encourages the clinician to pursue further biopsy to confirm a histological diagnosis. FDG-PET therefore assists in deciding which patients need to undergo further investigation.

FDG-PET as a "metabolic biopsy" tool in thoracic lesions with indeterminate biopsy.

A common problem encountered in clinical medicine is the classification of a lung lesion (nodule/opacity) on conventional imaging. Often attempts at biopsy are unsuccessful or are falsely reassuring, and the decision to send the patient for more invasive and potentially morbid procedures can be difficult. Our aim was to investigate the role of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) in helping to identify more accurately those patients with malignant lesions. Sixty-three patients underwent FDG-PET scans following unsuccessful biopsy of a lung lesion or, in a lesser number of cases, when an attempt at biopsy was considered too dangerous. Follow-up was by histology or, if this was unavailable, by clinical progress to death or a minimum of 18 months post scan. Visual and quantitative analysis was performed. On visual analysis, positive and negative predictive values were 90% and 100%, respectively. On quantitative (SUV>2.5) analysis, positive and negative predictive values were 90% and 85%, respectively. We interpret these results as showing that the use of FDG-PET scans in patients in this circumstance is non-invasive and highly sensitive in diagnosing malignancy. The high positive predictive value suggests that those with a positive scan must undergo further investigation, while the 100% negative predictive value means those with no FDG uptake can safely be spared further invasive investigations

Changes in physical activity patterns in the United States, by sex and cross-sectional age.

PURPOSE: To determine sex-specific, age-related changes in physical activity patterns. METHODS: We examined cross-sectional data from the National Health Interview Survey, using the 1992 Youth Risk Behavior Survey supplement for adolescents and the 1991 Health Promotion/Disease Prevention supplement for adults. Physical activity patterns were modeled after Healthy People 2000 objectives. RESULTS: Among adolescents, physical activity patterns generally eroded most from ages 15 through 18. The "regular, vigorous activity" and strengthening patterns declined consistently from ages 12 through 21. Young adulthood (18-29 yr) often marked continuing erosion of activity patterns, whereas middle adulthood (30-64 yr) often revealed relatively stable patterns. At retirement age (65 yr), there was a stabilizing, or even an improving, tendency in activity patterns, usually followed by further erosion through the final period of life. Strengthening behavior eroded dramatically with advancing age among adults, especially among men. Among adolescents, differences between female and male respondents were large for regular, vigorous activity (11.3 percentage points greater for male respondents). In comparison with female adolescents and adults, male respondents reported much higher rates of regular, sustained activity (5.5 and 5.9 percentage points, respectively), and strengthening (18.2 and 11.3 percentage points, respectively). Among adults, levels of physical inactivity among women were moderately greater (5.5 percentage points) than for men. Absolute rates of change per year were mostly large to very large (3.0-8.0 percentage points x yr(-1)) during ages 15-18 yr, but, for adults, they were small (<0.5 percentage points x yr(-1)) for 33 of 40 sex, age, and pattern groupings. CONCLUSION: These data suggest that early and continued intervention will be necessary to offset these declines in physical activity throughout adolescence and adulthood.

A browser based image bank, useful tool or expensive toy?

DIBS, the Digital Image Banking System, is a web browser based environment for depositing and withdrawing generic medical images. These can be annotated or modified on an individual's computer for use in talks and lectures. DIBS is programmed in 'C', to query and update a database as well as producing web pages on the 'fly'. Images are deposited using an interactive form, minimizing data entry and are received in a digital format or are digitized on demand. Three interfaces allow DIBS to be searched; an image map of the human body presents a simple graphical interface, whilst more specific searches can be performed by selecting categories from predefined scrolling menus or using a full text search. When a DIBS search is performed, preview thumbnail images and descriptions are provided, linked to the full size images that can be saved locally along with the text description. DIBS offers fast and convenient access to a wide range of medical images, eliminating the time consuming process of producing one's own slides or borrowing from colleagues. It is proving to be a useful tool within our Medical School but some copyright, ethical and image security issues still need to be resolved.