Diagnostic findings in sinonasal aspergillosis in dogs in the United Kingdom: 475 cases (2011-2021).

OBJECTIVES: To describe the diagnostic tests used and their comparative performance in dogs diagnosed with sinonasal aspergillosis in the United Kingdom. A secondary objective was to describe the signalment, clinical findings and common clinicopathologic abnormalities in sinonasal aspergillosis. MATERIALS AND METHODS: A multi-centre retrospective survey was performed involving 23 referral centres in the United Kingdom to identify dogs diagnosed with sinonasal aspergillosis from January 2011 to December 2021. Dogs were included if fungal plaques were seen during rhinoscopy or if ancillary testing (via histopathology, culture, cytology, serology or PCR) was positive and other differential diagnoses were excluded. RESULTS: A total of 662 cases were entered into the database across the 23 referral centres. Four hundred and seventy-five cases met the study inclusion criteria. Of these, 419 dogs had fungal plaques and compatible clinical signs. Fungal plaques were not seen in 56 dogs with turbinate destruction that had compatible clinical signs and a positive ancillary test result. Ancillary diagnostics were performed in 312 of 419 (74%) dogs with observed fungal plaques permitting calculation of sensitivity of cytology as 67%, fungal culture 59%, histopathology 47% and PCR 71%. CLINICAL SIGNIFICANCE: The sensitivities of ancillary diagnostics in this study were lower than previously reported challenging the clinical utility of such tests in sinonasal aspergillosis. Treatment and management decisions should be based on a combination of diagnostics including imaging findings, visual inspection, and ancillary testing, rather than ancillary tests alone.

Electrolyte measurements differ between point-of-care and reference analysers in dogs with hypoadrenocorticism.

INTRODUCTION: Dogs treated for hypoadrenocorticism are monitored through analysis of their blood electrolytes. This is routinely performed with point-of-care analysers and doses of medications are adjusted based on the results. OBJECTIVES: To investigate the performance of two point-of-care analysers (IDEXX Catalyst Dx and IDEXX VetStat) against a reference laboratory method for the measurement of blood sodium, potassium and chloride concentrations, as well as sodium: potassium ratios, in dogs diagnosed with and treated for hypoadrenocorticism. METHODS: Forty-eight dogs were enrolled into a prospective cross-sectional study. Paired blood samples were taken and tested on two point-of-care analysers and at a reference laboratory. Statistical analysis was then performed with Bland-Altman analysis and Passing-Bablok regression. The clinical effects of inaccurate electrolyte analysis were investigated. RESULTS: In total, 329 samples were tested on the Catalyst analyser, while another 72 samples were tested on the VetStat. Passing-Bablok regression identified both proportional and constant bias for some analytes. There was poor agreement between sodium and chloride concentrations on both analysers. Both analysers tended to give higher results than the reference method for all analytes, except for potassium when measured on the VetStat. CLINICAL SIGNIFICANCE: There are inherent differences between the electrolyte concentrations measured by these two point-of-care analysers and reference laboratory methods in dogs with hypoadrenocorticism.

Computed tomography in crepitant myonecrosis.

We report an unusual case of non-traumatic myonecrosis presenting as hip pain. Computed tomography helped to define the extent of the infection and its origin in the presacral space. The use of CT in diagnosis and management of gas-forming soft tissue infection is reviewed.

Investigation of colonic symptoms: the value of flexible sigmoidoscopy.

Colonic symptoms and large-bowel disease are common in elderly people, but the optimum investigative schema is not well established. Double-contrast barium enema (DCBE) and full colonoscopy share several drawbacks; both require colonic preparation which at best causes stool frequency and urgency, at worse dehydration and hypovolaemia. Many physicians feel that in the elderly this represents such a risk that inpatient preparation is preferred. Both investigations may involve much discomfort and distress. Rigid sigmoidoscopy is the traditional first colonic examination in patients with colonic symptoms, but will detect fewer than 10% of significant colonic lesions. Further investigation is almost always needed in elderly patients.

Age and blood pressure measurement: experience with the TM2420 ambulatory blood pressure monitor and elderly people.

The accuracy of the TM-2420 ambulatory blood pressure monitor was assessed in elderly people. Ninety-four subjects (44 men and 50 women), aged 60-94 with systolic blood pressure (SBP) of 97-208 mmHg and diastolic blood pressure (DBP) of 45-109 mmHg, including 23 with isolated systolic hypertension, were studied in three centres. The monitor was compared simultaneously with pairs of observers using the Hawksley random zero sphygmomanometer. The standard deviation of the difference (SDD) between observers was 4.2 mmHg (SBP), 2.9 mmHg (DBP). The mean difference was 0.49 mmHg (SBP) and 0.27 mmHg (DBP). The SDD between the monitor and the average of the observers' readings was 6.7 mmHg (SBP), 5.5 mmHg (DBP); the mean differences were 4.4 mmHg (SBP) and 4.8 mmHg (DBP). There were no significant differences between the two versions of the monitor used (5 and 7) or between the three pairs of observers. The monitor was equally accurate in isolated systolic hypertension (SDD observers and monitor 6.2 mmHg for SBP, 3.9 mmHg for DBP, mean differences 4.3 mmHg for SBP, 4.5 mmHg for DBP). Twenty-four-hour ambulatory blood pressure monitoring was carried out in 129 subjects aged 60-79; 89% of the monitoring attempted were successful with error rates of < 10%. The mean error rate was 3.8%. The device was well tolerated with only 4.7% of the subjects not completing a monitoring.

Irritable bowel syndrome: the influence of psychological factors on the symptom complex.

A 5 yr follow up of Irritable Bowel Syndrome (IBS) is described. With the notable exception of abdominal pain, gastrointestinal symptoms changed little over this period, and were unrelated to the overall improvement in wellbeing reported by 65% of patients. The anxiety ratings of the improved and unimproved groups at initial assessment and 5 yr later are considered. There was a persisting trend towards higher ratings in those who did not improve, and an exaggeration of this trend after 5 yr, which owed more to a reduction in anxiety in those who improved than to an increase in the anxiety ratings of those who did not. There was no evidence that depression ratings behaved similarly. We suggest that anxiety may be more important in the maintenance of the IBS symptom complex, and depression more important in determining intercurrent fluctuations in perceived distress and illness behaviour in response to adverse life events.

Irritable bowel syndrome: assessment of psychological disturbance and its influence on the response to fibre supplementation.

This study describes the effect of fibre supplementation on the gastrointestinal symptoms and general wellbeing of patients with constipated irritable bowel syndrome. In a single centre, double blind, placebo controlled trial of 3 months duration, a daily supplement of 4.1 g fibre produced no greater change in gastrointestinal symptoms than placebo. Pretreatment constipation was related to baseline fibre intake. Overall outcome was the same in treated and control groups; a considerable placebo response was evident. This level of fibre supplementation is not a useful treatment; improving neither constipation nor other symptoms. At the outset pain severity correlated with depression score on psychometric testing. Those who felt better at the end of the study scored significantly lower for depression at outset than those who felt no better. In irritable bowel syndrome a depressive emotional state profile is a powerful determinant of outcome, shaping the response to treatment, which includes a considerable placebo element.

Diarrhea and Fecal Incontinence.

In brief Two endurance athletes developed diarrhea and fecal incontinence each time they exercised strenuously. Such gastrointestinal difficulties are usually benign, but physicians determined that the disorders were an unusual presentation of lumbar spondylolisthesis in a runner and of jejunal diverticulosis in a cyclist. The runner's diarrhea and incontinence resolved when she avoided activities that precipitated her symptoms, and the cyclist's condition resolved with oral tetracycline.

Ambulatory blood pressure monitoring: validation of the accuracy and reliability of the TM-2420 according to the AAMI recommendations.

The accuracy of the TM-2420 ambulatory blood pressure monitor (A&D Co, Japan) has been assessed by the indirect method according to the recommendations of the Association for the Advancement of Medical Instrumentation (AAMI). Ninety subjects (43 men and 47 women), aged 19-89 with a range of systolic blood pressures (SBP) of 81-211 mmHg and diastolic blood pressures (DBP) of 32-113 mmHg were studied. The monitor was compared with two observers using the Hawksley random zero sphygomomanometer. The standard deviation of the difference (SDD) between the observers was 3.0 mmHg for SBP and 2.3 mmHg for DBP. The mean differences between observers were -0.31 mmHg for SBP and 0.32 mmHg for DBP (both NS). The average of three readings for each subject recorded by the monitor was compared with the average of the simultaneous readings by the observers. The SDD was 7.2 mmHg for SBP and 5.5 mmHg for DBP (within the recommendations for accuracy). The differences between methods were -0.98 mmHg for SBP and 0.18 mmHg for DBP; these differences were not significant (NS). The monitor was also assessed against direct intra-brachial artery pressure in 12 subjects (36 readings). The mean difference between the monitor and simultaneous individual intra-arterial reading was -9.5 mmHg for SBP (P less than 0.001) and 3.7 mmHg for DBP (P less than 0.001). The SDD's between methods were 12 mmHg for SBP and 5.0 mmHg for DBP. Use of the monitor in general clinical practice in 100 patients was also assessed. The rate of errors was low (6.8%), and the device found to be acceptable.(ABSTRACT TRUNCATED AT 250 WORDS)

Hyperprolactinaemia and nonpuerperal lactation associated with clomipramine.

Clomipramine in therapeutic dose was associated with nonpuerperal lactation and an elevated plasma prolactin. Both features resolved within weeks of discontinuing the drug.

Gastric and periurethral metastases from seminoma testis.

A case of seminoma testis with metastases to periurethral tissue and gastric submucosa is described. Response to treatment with irradiation and chemotherapy was good. Regression of the unusually sited tumour masses is demonstrated by barium meal and computed tomography. A brief review of gastric metastases is presented.

The impact of chemotherapy on small cell carcinoma of the bronchus.

Between 1971 and 1978, 140 cases of small cell anaplastic carcinoma of the bronchus were registered by a group of chest physicians in north Edinburgh. Sixty-five of these patients received specific treatment either with radiotherapy or cyclophosphamide and 75 patients were given treatment for symptoms only. Between 1979 and 1981 83 patients referred to the same physicians and pathologists were treated with combination chemotherapy (methotrexate, cyclophosphamide and CCNU) for 12 weeks. Overall median survival in the 1971 to 1978 group was two months with the actively-treated patients surviving for five months vs. less than one month for treatment of symptoms only. For the 83 patients treated with combination chemotherapy, median survival was nine months with 33 per cent alive at one year and 13 per cent at two years. Positive factors associated with prolonged survival included performance status at presentation and response to chemotherapy. This study demonstrates that the prognosis for the majority of patients with small cell carcinoma of the bronchus has improved significantly with the introduction of combination chemotherapy.