[Natural orifice transluminal endoscopic surgery in urology: feasability of a transrectal, flexible retroperitoneoscopy in a porcine model]. / "Natural orifice transluminal endoscopic surgery" in der Urologie : Machbarkeit einer transrektalen, flexiblen Retroperitoneoskopie im Schweinemodell.

BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) in urology is becoming more and more interesting due to technical innovations. One of those innovations is the HybridKnife®, a multifunctional sonde that combines high-frequency electrosurgery and water jet surgery. The aim of this study was to establish a transrectal, flexible endoscopic retroperitoneoscopy in a porcine model by means of the HybridKnife® for further development of a transrectal retroperitoneal NOTES lymphadenectomy (NOTES-RLA). MATERIAL AND METHODS: Five female pigs (25-30 kg body mass) were anesthetized and placed in a supine position. The rectal mucosa was opened 3-5 cm cranially of the linea dentata. After submucosal tunneling, the retrorectal space was opened. We performed a flexible endoscopic retroperitoneoscopy by means of a double-channel gastroscope 13.806 PKS (Karl Storz-Endoskope, Tuttlingen, Germany) and the HybridKnife® I-type (ERBE Elektromedizin, Tübingen, Germany). RESULTS: Transrectal access was safe and feasible without any difficulties. Using the HybridKnife® water jet technology, the retroperitoneal space could be distended which enabled safe access to the iliacal vessels, the bifurcation of the aorta/vena cava, and the pre- and paraaortal/-caval space up to the renal vessels. The water jet did not lacerate or injure blood vessels, nerves, or lymph vessels in any of the surgical procedures. CONCLUSIONS: By means of the HybridKnife®, transrectal access into the retrorectal space is safe and easily feasible. The water jet technology combined with electrosurgery prevented injuries of blood vessels, nerves, and lymph vessels and enabled transrectal flexible endoscopic retroperitoneoscopy as a precondition for further establishment of a transrectal NOTES-RLA.

Postoperative analgesic efficacy of meloxicam compared to tolfenamic acid in cats undergoing orthopaedic surgery.

OBJECTIVES: To investigate the efficacy of meloxicam or tolfenamic acid administered preoperatively and postoperatively (five days in total) to cats undergoing surgical fracture repair. METHODS: Eighty-eight otherwise healthy cats were matched according to fracture site and then randomly allocated to one of two groups, receiving 0·2 mg/kg meloxicam by subcutaneous injection (group M) or 1·5 to 3 mg/kg tolfenamic acid orally (group T) before anaesthesia. Analgesia was continued with 0.05 mg/kg oral meloxicam once daily or 1·5 to 3 mg/kg oral tolfenamic acid twice daily for four days postoperatively. Pain was assessed by a blinded observer using visual analogue scales and a functional limb score. The drug administrator assessed feed intake and palatability of the treatment. RESULTS: Data from 66 cats were analysed. Visual analogue scale pain scores and functional limb scores decreased over time in both groups but were not significantly different between treatments. Feed intake was similar in both groups. Meloxicam was significantly more palatable than tolfenamic acid on all treatment days. CLINICAL SIGNIFICANCE: Meloxicam and tolfenamic acid demonstrated comparable analgesia, without clinically observable side effects. Meloxicam may be associated with superior compliance in clinical practice due to the higher palatability and once daily treatment resulting in better ease of administration.

[Diagnostic value of CT and MRI for the diagnosis of coronoid pathology in the dog]. / Diagnostische Wertigkeit von Computertomographie und Magnetresonanztomographie für die Diagnose einer Koronoiderkrankung beim Hund.

OBJECTIVE: The diagnostic value of CT and MRI regarding the diagnosis of coronoid pathology in the dog. MATERIAL AND METHODS: Computed tomography (CT) and magnetic resonance imaging (MRI) of the elbow joint were performed in dogs with clinical and radiological signs of coronoid pathology. Afterwards, all dogs underwent arthroscopic surgery. For the computed tomographic examination, a 16-slice-CT-scanner spiral-CT (Philips Brilliance 16) was used. The MRI-examination was performed with a 1-Tesla superconducting magnet (Phillips Intera 1.0). T1 and T2 weighted images with different sequences were acquired. RESULTS: In total, 44 elbow joints from 44 patients (total of 12 breeds, including mixed breeds) were examined. The most represented breeds were Labrador Retrievers (38.6%, n=17), mixed breed dogs (22.7%, n=10) and Golden Retrievers (11.4%, n=5) were represented most. The age of the 30 male dogs (68%) and 14 female dogs (32%) ranged from 6 to 117 months (mean 2.25 years). Using CT, the following results could be evaluated: a) fissure at the level of the Processus coronoideus medialis ulnae (PCM) in 66% (n=29); b) fragments at the level of the PCM in 55% (n=24); c) deformation at the level of the PCM in all 44 joints; d) increased opacity at the level of the base of the PCM in all 44 joints; e) heterogenous opacity at the apex of the PCM in 91% (n=41). With MRI, the following results could be evaluated: a) fissure at the level of the PCM in 59% (n=26); b) fragments at the level of the PCM in 57% (n=25); c) deformation at the level of the PCM in 86% (n=38); d) increased opacity at the level of the base of the PCM, thus making assessment impossible; e) heterogenous opacity at the apex of the PCM, thus making assessment impossible. CONCLUSION AND CLINICAL RELEVANCE: Both diganostic imaging modalities are appropriate for evaluating coronoid pathology in the dog.

Systematic review of the management of canine osteoarthritis.

This review assesses the evidence for the efficacy of therapies used in the management of osteoarthritis in dogs on the basis of papers published in peer-reviewed journals in English between 1985 and July 2007. Sixty-eight papers were identified and evaluated. They considered four alternative therapies, one use of functional food, two intra-articular agents, six nutraceutical agents, 21 pharmacological agents, two physical therapies, three surgical techniques and two combinations of weight control. There was a high level of comfort (strong evidence) for the efficacy of carprofen, firocoxib and meloxicam, and a moderate level of comfort for the efficacy of etodolac in modifying the signs of osteoarthritis. There was a moderate level of comfort for the efficacy of glycosaminoglycan polysulphate, licofelone, elk velvet antler and a functional food containing green-lipped mussel for the modification of the structures involved in the disease. There was weak or no evidence in support of the use of doxycycline, electrostimulated acupuncture, extracorporeal shockwave therapy, gold wire acupuncture, hyaluronan, pentosan polysulphate, P54FP (extract of turmeric), tiaprofenic acid or tibial plateau levelling osteotomy.

No evidence for productive PERV infection of baboon cells in in vivo infection model.

OBJECTIVES: The discovery that pig endogenous retroviruses are infectious for human cells in vitro lead to vehement discussions about the possible risk of infection after clinical xenotransplantation. Since PERV transmission to non-human primate cells in vitro has been observed, similar to human cells, infection studies in non-human primates should represent the best model to analyze a potential PERV transmission after xenotransplantation. However, it is still open to discussion, whether non-human primate cells can be infected productively-similar to human cells- and whether those species are suitable to analyze PERV infection risks in vivo. METHODS: In vitro, only few cell types can be tested for susceptibility. We developed a pig to baboon cell transplantation model with special emphasis on B-cell effective immunosuppression, removal of anti Gal-alpha 1,3-Gal-antibodies, inhibition of the complement cascade and long term survival of transplanted cellular grafts. This model allows us to investigate in vivo, whether any baboon cell types may be permissive for productive PERV infection. The xenograft recipients were investigated for up to 535 days post transplantation. Gal-alpha 1,3-Gal-antibody and complement levels were monitored. Potential PERV transmission was analyzed, not only in PBMC, but in a variety of tissue samples as well as in serum and plasma samples by PCR, RT-PCR and by detection of RT-activity. Moreover, potential PERV specific immune responses were studied by a highly sensitive Western-Blot-assay. RESULTS: Despite several days of extremely low levels of Gal-alpha 1,3-Gal-antibody and complement, and despite of long term xenochimerism, no evidence for PERV infection was obtained in any of the tested tissues or in the tested serum samples. CONCLUSION: This study supplies further evidence for a low susceptibility of baboons towards productive PERV infection after xenotransplantation.

Porcine endogenous retroviruses (PERVs): generation of specific antibodies, development of an immunoperoxidase assay (IPA) and inhibition by AZT.

Xenotransplantation may be associated with the risk of transmission of microorganisms. In particular, the porcine endogenous retroviruses (PERV) have raised concerns as in vitro experiments show susceptibility of human cells for PERV infection. However, it remains unclear whether PERVs are able to infect transplant recipients in vivo and whether they are pathogenic. It is therefore essential that the risks are evaluated and for this purpose specific and sensitive screening methods for PERVs have to be developed. We generated specific antibodies against all major structural proteins of PERV and developed several assays which allow antibodies against PERV to be detected as indirect evidence of infection. For direct detection of PERV production, reverse transcriptase (RT) assays were used. PCR methods were used to detect provirus integration and the presence of viral mRNA. Here we present an immunoperoxidase assay (IPA), which would allow the detection of viral proteins in infected cells as well as antibodies against PERV in the serum of an infected host. The specificity of the sera used in the assay was determined by several methods, including immunoelectron microscopy, and the sensitivity of the assay was compared with other methods. This IPA was used to detect PERV infection in in vitro experiments for evaluation of the virus host range, for titrating the virus and for testing anti-viral properties of AZT. Using this method it was shown that AZT inhibits replication of PERV. This IPA may be very useful for the surveillance of preclinical and clinical xenotransplantations.

Sensitive and specific immunological detection methods for porcine endogenous retroviruses applicable to experimental and clinical xenotransplantation.

The use of organs from transgenic pigs for xenotransplantation may be associated with the risk of transmission of microorganisms, especially when the transgenic pigs express human proteins influencing complement activation. The porcine endogenous retroviruses (PERVs) are of particular concern as they can infect human cells in vitro. However, it is unknown whether PERVs can infect transplant recipients in vivo and, if so, whether they are pathogenic. It is therefore essential for experimental and clinical xenotransplantation procedures that specific and sensitive screening methods for PERVs are established. We developed Western blot and enzyme-linked immunosorbant assays (ELISA) based on purified PERVs produced by pig and human cells or recombinant viral protein and synthetic peptides corresponding to PERVs' transmembrane envelope protein, respectively. PERV-specific anti-sera generated against purified virus particles, purified viral proteins and synthetic peptides served as positive controls. Both assays were used for screening the sera of healthy blood donors, pregnant women, patients treated with pig tissues, and butchers with extensive contact to living porcine material to detect antibodies against PERV. None of the individuals showed an antibody pattern characteristic for retroviral infections. Some individuals had antibodies reactive against the major capsid protein p27, against smaller viral proteins of the group specific antigen (Gag) in Western blot assays, or against peptides in the ELISA, probably due to cross-reactivity. Here, we present specific and highly sensitive screening methods applicable for future xenotransplantation procedures, but using these methods we found no evidence of PERV-infection among humans potentially at risk.

Porcine endogenous retroviruses inhibit human immune cell function: risk for xenotransplantation?

Transgenic pigs are currently the most favored potential source of organs for xenotransplantation. Like all mammalian species they all harbor endogenous retroviruses in their genome. These porcine endogenous retroviruses (PERVs) are produced from several primary cells and cell lines and are able to infect human cells. Here we demonstrate that different pig strains and different animals of one strain differ in their ability to produce PERVs from normal blood cells. We report that purified PERV particles show a protein pattern typical for type C retroviruses and are antigenically related to mammalian leukemia viruses. Like most retroviruses, purified PERVs and peptides derived from the highly conserved immunosuppressive domain of their transmembrane envelope protein inhibit human immune cell functions. This indicates that high titer replication of PERVs in the transplant recipient could therefore lead to an immunodeficiency disease.

[Sevoflurane (SEVOrane) as an inhalation anesthetic in dogs in comparison with halothane and isoflurane]. / Sevofluran (SEVOrane) zur Inhalationsanästhesie beim Hund im Vergleich mit Halothan und Isofluran.

1969 Sevofluran was synthesized and in December 1995 licensed for clinical use in Germany. The low blood/gas partition coefficient is responsible for the fast uptake and elimination of sevoflurane. Sevoflurane does not irritate the airway. In human medicine no side effect of liver- and kidney function have been seen after sevofluran anaesthesia. There is low cardiovascular and respiratory depression caused by sevoflurane. In this study the use of sevoflurane in dogs should be tested and compared with isoflurane and halothane anaesthesia. All dogs were premedicated with /-methadon and diazepam. No significant depression of the cardiovascular system was seen. Neither kidney-nor hepatotoxic side effects could be found after sevoflurane, isoflurane and halothane anaesthesia. After sevoflurane anaesthesia the dogs woke up quietly and without any excitation and were able to stand on average ten minutes earlier after sevoflurane anaesthesia than after isoflurane and 85 minutes earlier than after halothane anaesthesia.

[Excision arthroplasty of the hip joint in dogs and cats. Long-term results of the veterinary surgery clinic at the Justus Liebig University of Giessen]. / Resektionsarthroplastik des Hüftgelenkes bei Hunden und Katzen. Ergebnisse einer Langzeitstudie an der Chirurgischen Veterinärklinik der Justus-Liebig-Universität Giessen.

Since the introduction of excision arthoplasty in veterinary medicine the question of indication is often asked. The maximum of the patient's body weight up to which surgery should be performed is another discussed problem. A long-term study from January 1985 to July 1995 at the Veterinary Surgery Department at the Justus-Liebig-University was carried out to answer these questions (222 patients, 155 dogs and 67 cats). Trauma and Legg-Calvé-Perthes disease came first in the list of indications. In case of postoperative problems trouble with lameness after high activity, long rest or at the time of change in weather could be seen. No owner of an animal thought that the life quality of his animal was restricted by this occasional problems. At a body weight over 30 kg the occasional problems were more often seen but every patient had less clinical problems after surgery than before. In this group no deterioration was seen.

[Total intravenous anesthesia (TIVA) with alphaxolon/alphadolon (Saffan) for permanent restraint of two cats with severe dyspnea]. / Die total intravenöse Anästhesie (TIVA) mit Alphaxolon/Alphadolon (Saffan) zur dauerhaften Ruhigstellung bei zwei Katzen mit schwerer Dyspnoe.

Total intravenous anaesthesia is a form of anaesthesia which is more often used in human medicine for high risk patients. The case reports of two cats with a severe dyspnoe are presented. Both patients received anaesthesia with the steroid anaesthetic agent Saffan for 19 and 25 hours, respectively. Saffan is a well-tolerated agent with little side effects. Dosage and monitoring results are presented.

[Sterility--a woman's concern? Coping behavior and partnership structure of sterile couples of various diagnostic groups]. / Sterilität--Frauensache? Bewältigungsverhalten und Paarstruktur von sterilen Paaren verschiedener Diagnosegruppen.

Three groups of sterile couples with functional, tubal and andrologically caused sterility were compared for the evaluation of sex- and diagnosis-dependent kinds of overcoming of their disease. Anamnestic data, anxiety, the coping strategy of sterility and as well the couple and personality structure are analysed. Independent of the organic cause of sterility the women showed a higher emotional reaction level (anxiety, coping stress) than their husbands. In all groups the "healthy" partners dominate. The subfertile men seem to be more subordinate, less engaged and interested and not so anxious as their wives and as the husbands of tubal sterile women. The healthy women with andrologically caused sterility present a highly emotional engagement in the overcoming and treatment of their disease. Possible emotional mechanisms and social stereotypes of self-presentation are discussed, which may cause the intense engagement of the women independent of the organic cause of sterility.