Visual-palpatory versus fluoroscopic intraoperative determination of the femoral entry point in medial patellofemoral ligament reconstruction.

PURPOSE: Malpositioning of the femoral entry point in reconstruction of the medial patellofemoral ligament (MPFL) can lead to abnormal and painful patellar kinematics and loss of flexion. Determination of this point is usually performed by palpation of anatomic landmarks. Accuracy of this method has not yet been investigated. The hypotheses were: 1. palpatory method is not as accurate as fluoroscopically guided method using established radiological criteria; 2. accuracy correlates with surgical experience. METHODS: Three surgeons of varying experience defined the femoral entry point for the MPFL by palpation in ten cadaveric legs. The blinded procedures were repeated three times, and subjective difficulty of the determination was recorded. Results were documented by fluoroscopy on a true lateral radiograph. The accuracy was assessed using established radiological criteria. Surgical experience was correlated with the results, and confounding or interacting variables were assessed. RESULTS: Mean deviation from the correct zone for the femoral entry point was 3.5 mm (range 0-18 mm). Twenty-nine percent of all palpatory determinations were inside the correct zone, 47 % were within 5 mm distance from the correct zone, and 23 % were further than 5 mm apart from the correct zone ("outliers"). No significant difference was found between surgeons of varying experience. No correlation was observed between subjective difficulty of the procedure and accuracy of determination. CONCLUSIONS: The validity of the isolated palpatory determination of the femoral entry point in MPFL reconstruction seems to be insufficient, regardless of surgical experience. Derived from this study, fluoroscopic guidance is used in our clinic by default.

Recurrent fever as the only or predominant clinical sign in four dogs and one cat with congenital portosystemic vascular anomalies.

Fever is not considered a typical clinical sign in animals with portosystemic vascular anomalies (PSVA). In a time period of 8 years, PSVA was diagnosed in 23 cases (20 dogs, 3 cats) at the Animal Hospital of the University of Zurich. Of these, recurrent fever was the only, the predominant or an early sign in 5 animals. Fever and associated unspecific clinical signs like lethargy, inappetence, and reluctance to move were present for weeks to months before the final diagnosis of PSVA was made. It was the lack of typical and well-known signs of PSVA that obscured and delayed the diagnosis. Therefore, PSVA should be included in the differential diagnosis of animals with fever of unknown origin (FUO).

Cisapride stimulates contraction of idiopathic megacolonic smooth muscle in cats.

We have previously shown that cisapride, a substituted piperidinyl benzamide, stimulates contraction of healthy feline colonic smooth muscle. The purpose of the present investigation was to determine the effect of cisapride on feline idiopathic megacolonic smooth muscle function. Longitudinal smooth muscle strips from ascending and descending colon were obtained from cats with idiopathic megacolon, suspended in a 1.5 mM Ca(2+)-HEPES buffer solution (37 degrees C, 100% O2, pH 7.4), attached to isometric force transducers, and stretched to optimal muscle length (Lo). Control responses were obtained at each muscle site with acetylcholine (10(-8) to 10(-4) M), substance P (10(-11) to 10(-7) M), or potassium chloride (10 to 80 mM). Muscles were then stimulated with cumulative (10(-9) to 10(-6) M) doses of cisapride in the absence or presence of tetrodotoxin (10(-6) M) and atropine (10(-6) M), or in a 0 calcium HEPES buffer solution. In cats with idiopathic megacolon, cisapride stimulated contractions of longitudinal smooth muscle from both the ascending and the descending colon. Cisapride-induced contractions were similar in magnitude to those induced by substance P and acetylcholine in the ascending colon, but were less than those observed in the descending colon. Cisapride-induced contractions in megacolonic smooth muscle were only partially inhibited by tetrodotoxin and atropine, but were virtually abolished by removal of extracellular calcium. We concluded that cisapride-induced contractions of feline megacolonic smooth muscle are largely smooth muscle mediated and dependent on influx of extracellular calcium. Cisapride-induced contractions in megacolonic smooth muscle are only partially dependent on enteric cholinergic nerves. Thus, cisapride may be useful in the treatment of cats with idiopathic megacolon.

Serum erythropoietin values in polycythemic cats.

Serum erythropoietin (EPO) concentrations and clinicopathological features were evaluated in 31 cats with absolute polycythemia (i.e., packed cell volume [PCV], 52% to 84%). Five cats had high serum EPO values and were classified as having secondary polycythemia. The remaining 26 cats had EPO values in the low or normal range. Four of these 26 cats had clinical evidence of secondary polycythemia and therefore were classified as having secondary polycythemia. In the remaining 22 cases, no signs of secondary polycythemia could be found, and primary polycythemia was diagnosed. A low or normal serum EPO value in a polycythemic cat is consistent with primary polycythemia, but does not exclude secondary polycythemia.

[Bone segment transport in femoral defects. Animal experiment study]. / Der Knochensegmenttransport bei Femurdefekten. Tierexperimentelle Studie.

The aim of our experimental study was to realize the Ilizarov concept using a reamed intramedullary interlocking nail with an internal transport system. In 8 mature dogs a bone defect of 3 cm was performed at the femur. A distally osteotomized bone fragment (length 3.5 cm) was lowered through the bone defect. 4 times we had to exclude the animal from the evaluation. In this case the interlocking nails were broken within 6 weeks. In 3 dogs a regeneration of bone was found in the defect. In 6 dogs a deep infection along the transport system had developed.

[Serious reactions after the TSH-stimulation test in the dog]. / Schwerwiegende Reaktionen nach TSH-Stimulationstest beim Hund.

The thyrotropin response test is the most common test for the diagnosis of hypothyroidism. Here we report serious adverse effects in two dogs after intravenous administration of bovine TSH. The clinical signs were consistent with an anaphylactoid or anaphylactic reaction. In both cases a previous sensibilization with bovine TSH can be excluded. We discuss the etiology and emphasize the most probable cause to be an anaphylactoid reaction. Preventive measures are discussed.

A controlled trial of a low sodium, low fat, high fibre diet in treated hypertensive patients: effect on antihypertensive drug requirement in clinical practice.

The effect of a low sodium, low fat, high fibre diet in allowing a reduction of antihypertensive medication was compared with the effect produced by the individual components of this diet in an observer-blind controlled trial using 196 patients with essential hypertension. Patients were followed up 1.5 months after the last change in medication. In the control group a 33% reduction in medication was possible, with 24% of patients off medication altogether. The low fat, high fibre and low sodium groups showed larger reductions in medication (38%, 47% and 45% respectively), but not significant compared with the control group. The combination group had the largest and highly significant medication reduction (64%), and significantly more patients stopped medication (57.5%), compared with the control group. Since compliance assessment closely corresponded to normal clinical practice these results should represent what is possible in routine clinical practice. This is of importance as drug treatment has side effects, and may be associated with increased cardiovascular risk not found with dietary alternatives.

A controlled trial of a low sodium, low fat, high fibre diet in treated hypertensive patients: the efficacy of multiple dietary intervention.

An 8-week combination low sodium, low fat, high fibre diet was compared to the individual components of this diet in a controlled trial using 193 patients already on treatment for essential hypertension. No significant changes were observed in the high fibre group. The low sodium group showed a decrease in systolic blood pressure which was close to significance. The low fat group showed a small but significant decrease in seated diastolic blood pressure and weight. The combination group showed larger and highly significant decreases in seated and standing systolic blood pressures, seated diastolic blood pressure and weight, as well as a significant reduction in standing diastolic blood pressure. We conclude that multiple dietary intervention in this case in the form of a low sodium, low fat, high fibre diet, is more effective than any single dietary intervention and is useful in patients already on medication.

The effect of a combination low sodium, low fat, high fibre diet on serum lipids in treated hypertensive patients.

The effect of a combination low sodium, low fat, high fibre diet on serum lipids in 184 treated hypertensive patients was analysed in a controlled trial. The combination diet caused a small but significant reduction in serum triglyceride and total cholesterol. This was apparently due to the low fat component of the diet, since a low fat diet alone also caused a similar reduction in total cholesterol, whereas a high fibre diet or a low sodium diet alone caused no significant changes in serum lipids. Analysis of the medication subgroups suggests that diuretics may allow more favourable changes in lipid profile than betablockers. The combination diet and the low fat diet both caused a significant reduction in HDL cholesterol. Thus there was no significant change in the HDL ratio for the combination group and a significant decrease in this ratio for the low fat group. Furthermore the magnitude of changes in total and LDL cholesterol in the low fat and combination groups was much smaller compared to previously observed changes in untreated patients. The overall limited benefit of the combination diet, and possibly adverse effect of the low fat diet, may contribute to the limited effect of therapeutic intervention on mortality from ischaemic heart disease seen in previous studies.

Imprinting to chemical cues: the basis for home stream selection in salmon.

Juvenile coho salmon were exposed to morpholine or phenethyl alcohol (p-alcohol) for 1 1/2 months and then released in Lake Michigan. During the spawning migration 18 months later, morpholine and p-alcohol were metered into separate streams, and the number of morpholine- and p-alcohol-exposed fish returning to each stream was determined. Seventeen other locations were also monitored. The majority of the fish exposed to morpholine were captured in the stream scented with morpholine and most fish exposed to p-alcohol were captured at the p-alcohol-treated stream. This field study demonstrates that coho salmon imprint to and utilize chemical cues for homing.

Electroencephalographic evidence for retention of olfactory cues in homing coho salmon.

Differences were observed in the magnitude of the evoked electroencephalographic response to 1 percent morpholine for homing coho salmon (Oncorhynchus kisutch) exposed to morpholine as fingerlings 1 month before smolting as compared to salmon not exposed to morpholine as fingerlings. These results indicate that olfactory information has been retained for 18 months, the period between smolting and the homeward migration.