Triple tibial osteotomy for treatment of the canine cranial cruciate ligament-deficient stifle joint. Surgical findings and postoperative complications in 97 stifles.

OBJECTIVE: To report the surgical findings and early post-operative complications of triple tibial osteotomy (TTO) for the treatment of cranial cruciate ligament disruption in dogs. METHODS: Clinical records of 84 dogs (97 stifles) that had TTO procedures were reviewed. Surgical findings and postoperative complications were assessed. A complication was defined as any undesirable outcome resulting from TTO that required further diagnostic investigation or surgical treatment. RESULTS: Mean tibial wedge angle was 13.6 degrees (range 10-20). Incomplete tibial crest osteotomy was achieved in 79% of TTO procedures. Implants were placed in the tibial crest in 67% of stifles. Early postoperative complications occurred in 23% of joints, and included avulsion of the tibial crest (9.1%), fracture at the distal cortical attachment of the tibial crest (6.2%), fibula fracture (4.1%), patellar tendonitis (3.1%), late meniscal injury (3.1%), implant complications (3.1%) and patellar fracture (2.1%). Increased patient age (p = 0.023), increased wedge angle (p = 0.009) and intra-operative fracturing of the cranial tibial cortex (p = 0.017) were significantly associated with postoperative tibial crest avulsion. Implants did not prevent tibial crest avulsion. Increased patient age (p = 0.012) was significantly associated with tibial crest fracture. CLINICAL RELEVANCE: Tibial crest avulsion and fracture are the most common postoperative complications for TTO. Late meniscal injury is uncommon after TTO.

Beamline I11 at Diamond: a new instrument for high resolution powder diffraction.

The performance characteristics of a new synchrotron x-ray powder diffraction beamline (I11) at the Diamond Light Source are presented. Using an in-vacuum undulator for photon production and deploying simple x-ray optics centered around a double-crystal monochromator and a pair of harmonic rejection mirrors, a high brightness and low bandpass x-ray beam is delivered at the sample. To provide fast data collection, 45 Si(111) analyzing crystals and detectors are installed onto a large and high precision diffractometer. High resolution powder diffraction data from standard reference materials of Si, alpha-quartz, and LaB6 are used to characterize instrumental performance.

Role of canonical Wnt-signalling in joint formation.

The individual elements of the vertebrate skeleton are separated by three different types of joints, fibrous, cartilaginous and synovial joints. Synovial joint formation in the limbs is coupled to the formation of the prechondrogenic condensations, which precede the formation of the joint interzone. We are beginning to understand the signals involved in the formation of prechondrogenic condensations and the subsequent differentiation of cells within the condensations into chondrocytes. However, relatively little is known about the molecules and molecular pathways involved in induction of the early joint interzone and the subsequent formation of the synovial joints. Based on gain-of function studies Wnt-signalling, in particular the canonical pathway, has been implicated in the joint induction process. Here we provide genetic evidence from loss-of function analysis of embryos lacking either the central player of the canonical Wnt-pathway, beta-catenin, in the limb mesenchyme or the two ligands, Wnt9a and Wnt4, demonstrating that canonical Wnt-signalling plays an important role in suppressing the chondrogenic potential of cells in the joint thereby actively allowing joint formation. Furthermore our data show that the beta-catenin activity is not essential for the induction of molecular markers expressed in the joint interzone. Thus, suggesting that canonical Wnt-signalling is not required for the induction, but for the subsequent maintenance of the fate of the joint interzone cells.

Omentalisation of perinephric pseudocysts in a cat.

An 11-year-old male domestic shorthaired cat was presented with behavioural disturbances and abdominal distension of two days' duration. Haemobartonella felis was found on routine haematology and serum biochemistry showed mild azotaemia. Abdominocentesis revealed a transudate. Bilateral perinephric fluid accumulations were observed on ultrasonography and chronic nephrosclerosis was diagnosed on needle biopsies of the kidney. A celiotomy with resection of the major portion of both cyst walls was performed. The omentum was extended along the floor of the abdomen, across the ventral aspect of both kidneys and attached to the remnants of the pseudocyst wall. Ongoing physiological drainage was secured and cyst recurrence was prevented. Perirenal fluid was not detected at clinical and ultrasound follow-up examinations 14 days and seven months postoperatively. Mild azotaemia and refractory Haemobartonella infection were, however, still present.

Vulvovaginectomy and neo-urethrostomy for treatment of haemangiosarcoma of the vulva and vagina.

Vulvovaginectomy and neo-urethrostomy were performed in a 9-year-old German shepherd dog following a diagnosis of infiltrative vulvar and vestibulovaginal haemangiosarcoma. The dog was presented for intermittent vulvar haemorrhage over a 3-month period. On examination the vulva and vestibulovagina were distended and firm. Vaginal discharge and fine needle aspiration cytology detected anaplastic cells. Haemangiosarcoma was diagnosed on biopsy. A new urethral opening was created in the floor of the vagina allowing resection of the vulva and caudal vestibulovagina. Urinary continence was preserved and healing was without complications.

Health care: a social contract in transition.

Health care reform around the world is born in considerable measure of the need to reconcile our growing capacity to provide effective health care with diminishing economic means to sustain this capacity indefinitely. It is precisely under these circumstances that the conflict between individual rights to health care and the state's responsibilities to provide it becomes unavoidable. Although it cannot be eliminated, the conflict can be managed. But the task requires us to go beyond formulating economic policies or designing new structural systems for delivering health care. It requires an understanding of the purpose of health care for individuals and society. It includes stipulating limitations for individual rights and state responsibilities. Because of these limitations, the task must be guided by the requirements of justice. Health care as both a private and common good is at the center of a distributive struggle. At one level the focus of this struggle is economic and political. At another level it is moral and revolves around the concept of health itself, considered in its biological, psychological and social dimensions. Here the issue becomes health as a right, together with the implications such a right has for our efforts to balance the freedom of individual health-related behavior with the interests of the public's health. What, in that balance, are the rights of the individual and the responsibilities of the state? Can the individual citizen hold the state accountable for securing the conditions necessary for health? Can the state hold its citizens accountable for irresponsible health-related behavior? A discussion of providing liver transplantation sheds considerable light on these questions, while suggesting a paradigm for use with general health care services. Central to this paradigm is the welfare concept of right, balanced by the understanding that a citizen's claim on health care services is limited. In the final analysis, justice in health care will be achieved through a division of labor, at the center of which there is a set of reasonable and binding expectations shared reciprocally between the individual and the state.

The cultural and philosophical foundations of normative medical ethics.

Thirty years ago, the idea that culture and philosophy could provide a foundation for normative medical ethics was more easily entertained than it is today when the very notion of a norm, whether culturally, philosophically or ethically derived, is in itself a problem. In large measure this comes from our contemporary embrace of cultural and philosophical pluralism and an increasing tendency to exchange the difficult belief in abstract and universally applicable norms for the more accessible notion that ethical values are cultural and relative derivatives. Despite this, in the face of the unprecedented ethical dilemmas presented by modern medicine, we have attempted to apply traditional ethical norms and analysis to modern medicine to establish a consensus for its right practice. Unfortunately, the attempt has not been successful, so that wherever we turn we find that ethical problems in medicine remain intractable and unresolved. That, in turn, has prompted a certain scepticism about the efficacy of ethics in medicine. In order to understand why we have reached this impasse, it is essential to realize that we have seriously underestimated the way science and technology have informed and, as a consequence, transformed the practice of medicine. Contributing to this, our tendency to think of technology simply as a way of doing things has blinded us to the fact that it is more fundamentally a way of thinking, knowing and valuing.(ABSTRACT TRUNCATED AT 250 WORDS)

Sartorius muscle contracture in a dog.

An adult male German Shepherd dog presented with a chronic non-painful, non-weight bearing lameness of the right hind limb. On clinical examination a contracted sarotorius muscle was palpable. Histopathology of the affected muscle confirmed replacement fibrosis and muscle contracture. Surgical excision of the muscle resulted in complete recovery.

Giving voice to the pragmatic majority in New Jersey.

KIE: This is one of a set of six short articles, grouped under the umbrella title "Grassroots bioethics revisited: health care priorities and community values," with a very brief introduction by Bruce Jennings. The articles focus on the involvement of community health decisions projects with public policy issues of access to health care, allocation of resources, setting health care priorities, cost containment, and rationing.^ieng