Prospective evaluation of techniques for differentiating shoulder pathology as a source of forelimb lameness in medium and large breed dogs.

OBJECTIVE: To assess lameness evaluation, shoulder abduction angles, radiography, and ultrasonography for determining presence, location, and severity of forelimb pathology. STUDY DESIGN: Prospective cohort study. ANIMALS: Dogs >or=20 kg (n=30). METHODS: Each dog was assigned lameness scores. Shoulder abduction angles were determined. Radiographs of shoulders and elbows were subjectively graded for pathology. One investigator unaware of dog history (lameness, radiographic findings) performed ultrasonographic assessment of shoulders with subjective grading of pathology. Another investigator unaware of dog history (lameness, radiographic, ultrasonographic findings) performed arthroscopic assessment of shoulders with subjective grading of pathology. Elbows were disarticulated and evaluated for gross pathology. Histologic pathology scoring of shoulder tissues was performed. Data were compared for differences among groups, sensitivities, specificities, positive and negative predictive values, and positive and negative likelihood ratios were calculated. RESULTS: Twenty-seven forelimbs were considered clinically normal, 26 had shoulder pathology, 5 had elbow pathology, and 2 had pathology of both the shoulder and elbow. Dogs with shoulder pathology were twice as likely to be lame compared with dogs with elbow pathology. Limbs with medial shoulder instability had significantly higher abduction angles than normal limbs and those with elbow pathology. Radiographs were clinically useful for diagnosing elbow, but not shoulder, pathology. Ultrasonography was clinically useful for diagnosing shoulder pathology other than instability. Abduction angles, ultrasonographic evaluation, and arthroscopic assessments had strong, significant correlations with reference standards. CONCLUSIONS: Clinically relevant diagnostic techniques yielded characteristic, repeatable differences in objective and subjective assessments for distinguishing presence, location, and severity of forelimb lameness in dogs. CLINICAL RELEVANCE: The diagnostic approach to forelimb lameness in dogs should include shoulder pathology as a differential with multiple assessments used to determine the clinical cause of lameness.

Nonsteroidal antiinflammatory drugs: a review.

The increasing use of nonsteroidal antiinflammatory drugs (NSAIDs) in small animals has resulted in the development of new and innovative additions to this class of drugs. Examples of NSAIDs now available for use in small animals include aspirin, etodolac, carprofen, ketoprofen, meloxicam, deracoxib, and tepoxalin. The purposes of this article are to review the pathophysiology of prostaglandin synthesis and inhibition, the mechanisms of action, pharmacokinetics, pharmacological effects, and potential adverse reactions of aspirin and the newly released NSAIDs.

Transitional cell carcinoma presenting as clitoral priapism.

BACKGROUND: Clitoral priapism is an uncommon cause of clitoromegaly. It should be suspected in the absence of hirsuitism and the presence of clitoral engorgement, pain, and local irritation. CASE: A 48-year-old female had a straight catheterization of her bladder for a history of frequent urinary tract infections. She was noted to have a clitoral size of 5 x 2.5 cm along with the classic findings of priapism. She had an 8 x 10 cm pelvic mass that was biopsied and revealed transitional cell carcinoma with papillary squamous component. CONCLUSION: Clitoral priapism presents with clitoral engorgement in the absence of sexual stimulation. The most common etiologies include medications, pelvic tumors, blood dyscrasias, or retroperitoneal fibrosis. A thorough investigation is warranted to identify potential pelvic venous or lymphatic obstruction.

Lung cancer metastatic to a cervical polyp.

BACKGROUND: We describe an unusual finding of a lung cancer metastatic to a cervical polyp. CASE: A 69-year-old female with metastatic lung cancer was referred for evaluation of an asymptomatic cervical polyp. The polyp was removed and pathologic examination revealed a focus of invasive adenocarcinoma with signet ring features within a polypoid fragment of squamous mucosa. All studies suggest a primary pulmonary origin. CONCLUSION: Cervical polyps occur in up to 5% of women and 1.7% contain carcinomatous changes. Most malignant polyps result from the progression of localized dysplasia, but distant metastases have been reported. We were unable to find any prior report of a primary lung cancer metastatic to a cervical polyp. Although removal or biopsy of asymptomatic polyps is reasonable, further studies need to be done.

The effects of peer counseling on smoking cessation and reduction.

OBJECTIVE: To evaluate a peer counseling intervention for pregnant smokers. METHODS: One hundred forty-two pregnant, predominantly Hispanic women were assigned to a peer-led smoking cessation program or to usual care. RESULTS: Compared with usual care, peer counseling reduced smoking (-9.1 versus -4.5 cigarettes daily, P =.03), but did not affect absolute quit rates (24% versus 21%) at 36 weeks' gestation. Infant birth weight negatively correlated with cigarettes smoked per day (r = -0.29, P <.01) and expired carbon monoxide (r = -0.39, (P <.001) at delivery. Birth weight for infants born to women who quit smoking averaged 7.2 lb versus 6.8 and 6.3 lb for mothers smoking one to six and more than six cigarettes per day at delivery (P <.01). CONCLUSION: Peer counseling reduced the number of cigarettes smoked daily but did not increase cigarette abstinence rates. Infant birth weight increases with both smoking cessation and smoking reduction, suggesting that peer counseling intervention programs may improve newborn health despite their failure to affect smoking cessation.

Primary hyperparathyroidism in pregnancy: evidence-based management.

UNLABELLED: Primary hyperparathyroidism during pregnancy poses significant risks to the mother and the fetus. Fortunately, prompt diagnosis and effective management can improve outcomes for both. There is controversy regarding appropriate management of these patients, especially late in gestation. The objective of this article, therefore, is to review the literature and to propose an evidence-based approach to managing these patients. The prevalence of primary hyperparathyroidism in the general population is 0.15%. This condition is more common in women and 25% of cases appear in women during the childbearing years. The true incidence during pregnancy, however, is not known. Because up to 80% of gravid patients with primary hyperparathyroidism are asymptomatic, diagnosing this condition is more difficult. Complications associated with primary hyperparathyroidism in pregnancy have been reported to occur in up to 67% of mothers and 80% of fetuses. In addition to many constitutional symptoms, maternal complications include nephrolithiasis, bone disease, pancreatitis, hyperemesis, muscle weakness, mental status changes, and hypercalcemic crisis. Reported fetal complications include intrauterine growth retardation, low birth weight, preterm delivery, intrauterine fetal demise, postpartum neonatal tetany, and permanent hypoparathyroidism. A four-fold decrease in perinatal complications may be achieved with appropriate therapy. Conservative intervention may be appropriate under certain circumstances, but excision of a parathyroid adenoma remains the only definitive treatment. Debate continues regarding the safety of surgery in the third trimester. However, several cases of successful surgery have been reported. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to describe the typical presentation of a patient with hyperparathyroidism, summarize the work up and management of a patient with hyperparathyroidism, and list the treatment options for a pregnant patient with hyperparathyroidism.