bluuebunny/crossref_metadata_2025 huggingface dataset:
An ovine model of cranial cruciate ligament reconstruction
Authors: Adachi N. , Ochi M. , Field J. R.
Published: March 2018

Unilateral cranial cruciate ligament (CrCL) reconstruction was performed in forty-eight sheep, to evaluate an absorbable tibial fixation device (Gunze Ltd. Japan/Zimmer Japan). Forty-four (91.6%) were available for end-point evaluation. A medial subpatellar arthrotomy was utilized with graft placement accomplished using the Acufex Graftmaster system (Acufex, Mansfield, MA). A prosthesis was implanted consisting of looped superficial flexor tendon autograft joined to a Leeds- Keio ligament (LK-15). Femoral fixation was accomplished with an endobutton and tibial fixation with staples. Individuals were required to weight-bear immediately following recovery from anaesthesia and in so doing mimic the early mobilization practices currently in vogue in humans following anterior cruciate ligament reconstruction.

An analgesia protocol involving intraarticular sensory blockade and intravenous agents was utilized and appeared effective in the provision of adequate levels of comfort post- operatively. The model has allowed a significant amount of relevant data to be obtained prior to clinical trials in humans.

Cruciate ligament reconstruction in human patients is often with a view to returning the patient to strenuous athletic endeavour. This paper is presented, not only as a means of displaying what technologies are currently in use in the human patient, but also as a means of suggesting to colleagues, in both the medical and veterinary professions, how research into cruciate reconstruction, using animal models, might be performed with peri-operative care of the animal being of paramount importance.
A method for visualizing the dorsal acetabular rim and the coverage of the femoral head
Authors: Hoskinson J. , Renberg W. C.
Published: March 2018

The authors describe a new technique to visualize the dorsal acetabular rim and the coverage of the femoral head in the nonsedated dog. The technique involves using an overhead beam, directed at an angle tangential to the dorsal rim of the acetabulum, with a film positioned caudal to the standing dog. Anatomical landmarks that can routinely be identified include: the ilial crest, ilial shaft, ischial tuberosity, acetabulum, acetabular rim (particularly the dorsocaudal component), femoral head, greater trochanter, femoral neck, femoral shaft, rectum and the tail. Because the animal is standing and is not sedated, the technique may have additional value as a means of evaluating subluxation of the hip joint. It maintains a posture as close as possible to that experienced by the animal in normal activity. If the technique has prognostic value in that regard, more investigation is needed, but it is useful in itself as a technique to visualize the area of the acetabulum.

A new radiographic technique to evaluate the canine hip joint is described. The view involves tangential projection of the acetabulum in the standing, awake dog. Nineteen dogs have been radiographed to develop the technique and the method has been found to be technically simple and consistent. It allows examination of the dorsal acetabular rim and may help examine the amount of subluxation of the hip as well as the presence of any degenerative joint disease. The authors advocate additional study to determine the technique’s prognostic value in predicting degenerative change associated with hip dysplasia.
In vitro comparison of the holding power of 1.2 mm, 1.5 mm, and 2.0 mm orthopaedic screws in canine radii
Authors: Fitch R. B. , Pluhar G. E. , Salman M. D. , Kudnig S. T.
Published: March 2018

The holding power of miniscrews in canine bone has not been investigated. This report compares the holding power of four different miniscrew types. The screw types tested were: 1.2 mm self-tapping screws, 1.5 mm tapped screws, 2.0 mm self-tapping screws and 2.0 mm tapped screws. They were randomly allocated to canine radius screw sites and screw pull-out strength was determined using a Mechanical Testing System (MIS) machine. The 1.2 mm self-tapping screw had a significantly weaker holding power than the other three screw types. Based upon these findings, the use of the 1.2 mm self-tapping screw cannot be recommended for use in thick cortical bone. There were not any significant differences in holding power of the other three screw types. The performance of the 1.5 mm tapped screws, versus the 2.0 mm tapped screws, was comparable and suggests that the 1.5 mm tapped screw can provide adequate holding power in miniscrew applications. The results were consistent with a linear relationship between the external thread diameter and the holding power.

The hypothesis of this study is that these are not any significant differences in the holding power of different miniscrews. We hypothesized that the effects of tapping prior to screw insertion, or using miniscrews of greater external thread diameter, would not provide any increase in the holding power of the screw.
Post-traumatic para-ureteral urinoma (uriniferous pseudocyst) in a cat
Authors: Anderson D. M. , Baines E. A. , White R. A. S. , Bacon N. J.
Published: March 2018

A para-ureteral urinoma was diagnosed in a one year old domestic longhaired cat presented with signs of lethargy and abdominal distension three weeks after a road traffic accident. The urinoma was caused by chronic low-grade extravasation of urine from the left ureter into the retroperitoneal space, resulting in cellulitis producing a thick fibrous capsule around the urine. Left sided ureteronephrectomy with capsular resection and omentalisation was curative.
Treatment of mechanically failed triple pelvic osteotomies in four dogs - part 2
Authors: Kerwin S. , Hosgood G. , Marquis R. D. , Pluhar E. , Kudnig S. T. , Fitch R. B.
Published: March 2018

Four dogs treated with triple pelvic osteotomies (TPOs) with loss of fixation secondary to screw loosening are reported. Two of the patients were revised with an additional ventral plate with successful outcomes. Revision TPO, with additional ventral plate fixation, was highly effective as a salvage technique for failed TPOs.
Initial experience with extracorporeal shock wave therapy in six dogs – part I
Authors: Laverty P. H. , McClure S. R.
Published: March 2018

Extracorporeal shock wave therapy (ESWT) may be an effective treatment modality for delayed or chronic non-union fractures. ESWT is a non-invasive technique that avoids the potential morbidity and mortality associated with traditional surgical procedures, and its use does not preclude subsequent surgical treatment. This case series demonstrates the feasibility, versatility and safety of treating dogs with ESWT.
Initial experiences with extracorporeal shock wave therapy for treatment of bone spavin in horses – part II
Authors: McCarroll G. D. , McClure S. R.
Published: March 2018

Extracorporeal shock wave therapy (ESWT) has grown from the original use of treating urinary calculi into a mechanism to treat some specific orthopaedic diseases of humans and animals. This paper describes a group of horses with bone spavin treated with ESWT. Horses were treated with a high energy focused shock wave machine. Horses were examined for lameness pre-treatment and 12 weeks post-treatment. There was a decrease in the lameness of 80% (59/74) of the horses treated. ESWT provides a viable noninvasive mechanism of treating refractory bone spavin in the horse.
Geometric analysis evaluating the effect of tibial plateau leveling osteotomy position on postoperative tibial plateau slope
Authors: McCarthy R. J. , Kowaleski M. P.
Published: March 2018

The tibial plateau leveling osteotomy procedure is designed to neutralize cranial tibial thrust by precisely reducing tibial plateau slope. Despite accurate intraoperative measurement and proximal tibial plateau segment rotation, postoperative assessment of tibial plateau slope frequently reveals a measured angle differing from the expected postoperative angle of 5.0 degrees. The effect of osteotomy placement on postoperative tibial plateau slope was evaluated by analysing its effect on the points utilized in tibial plateau slope measurement. Four osteotomy placements, encompassing the point dividing the intercondylar tubercles and an osteotomy centred on this point, were evaluated. The effect of centreing the osteotomy distal to the intercondylar tubercles was more closely evaluated. Formulae to determine the distance the intercondylar tubercles move, the angular shift of the tibial long axis after proximal tibial plateau segment rotation, and the relation of the final and intended tibial plateau slope were derived. Osteotomy placement centred on the proximal tibial long axis point results in a lack of movement or angular shift of the tibial long axis, after proximal tibial plateau segment rotation. Other osteotomy placements result in movement of the intercondylar tubercles, tibial long axis shift, and deviation from the expected postoperative tibial plateau slope. Centreing the tibial plateau leveling osteotomy on the proximal tibial long axis point is the mathematically correct position.
Accessory caudal glenoid ossification centre as possible cause of lameness in nine dogs
Authors: Piras A. , Marcellin-Little D. J. , Borghetti P. , Vezzoni A. , Olivieri M.
Published: March 2018

An accessory centre of ossification was identified on the caudal aspect of the glenoid (ACGOC) in nine dogs. In three of the dogs, concomitant lesions were found in the same shoulder joint. When they appeared to be loose, the fragments were removed using arthroscopy in eight dogs. Upon histological examination in four dogs, the presence of articular cartilage on these ACGOC confirmed the fact that they represented a portion of the glenoid. The resolution of the clinical signs in six cases with isolated ACGOC after fragment excision and without concomitant lesions suggests that ACGOC was the cause of lameness in these affected dogs.
Torque recoil following screw insertion
Authors: Field J. R.
Published: March 2018

Our ability to apply screws in a uniformly reproducible manner using “human torque control” has been shown to be very inconsistent. As a means of reducing this variability, torque-limiting devices are being utilized in select trauma and spinal applications. Cortical, cancellous and pedicle screws are now applied to a set, predetermined level of torque. It has been shown that extraction torque can be a little as 10% at the torque level at the time of application at plate removal 10 weeks after application. Using cadaveric specimens, the current study has evaluated the extraction torque immediately after application to a predetermined level. Regardless of the specimen, or location within the specimen, a significant difference was observed between the set application torque (1.5 Nm) and that obtained at the time of extraction (0.9 Nm). Some values were as low as 33% of the insertion value. This work suggests that in order to standardize interfragmentary compression, or bone plate fixation, we can not rely upon screw torque as the means of defining screw behaviour. Displacement control would appear to be the key to enable adaptation to the differing mechanical and biological nature of the bone and to overcome the recoil observed.
Inflammatory response in dogs with spontaneous cranial cruciate ligament rupture
Authors: Ekman S. , Andersson M. , Danielsson F.
Published: March 2018

The inflammatory response in 73 dogs with spontaneous rupture of the cranial cruciate ligament was studied. Collagen I and II antibodies (CI, CII), antinuclear antibodies (ANA) and anti-neutrophil cytoplasmic antibodies (ANCA) in synovial fluid (SF) and serum were analysed, as well as serum thyroxine (T4) and free thyroxine (fT4). The type and degree of synovitis did not affect the concentration of antibodies to CI&II. The histological findings of the synovial membranes in 47 dogs were graded as mild non-specific synovitis in 21%, moderate nonspecific synovitis in 32%, moderate lymphoplasmacytic synovitis in 36% and nodular lymphoplasmacytic synovitis in 11% of the dogs. Of 45 dogs four had lower than normal concentration of T4 and fT4. There was not any evidence of a primary autoimmune response.
Morphological measurements for arthrosis risk in elbow dysplasia: a new method?
Authors: Schwencke M. , van den Brom W. E. , Hazewinkel A. W. H.
Published: March 2018

Elbow dysplasia refers to malformations of the elbow joint, which predominantly occurs in young dogs of large breeds. Labradors are especially affected with fragmented coronoid process and osteochondritis dissecans of the elbow joint that often leads to secondary osteoarthrosis (OA). Mues (16) developed an angle measurement method, presuming that these measurements describe functional aspects of the elbow joints, suitable to characterize the risk of developing OA. The aim of the present studies was to examine whether the morphology of the elbow joint, or the size of the osteophytes in the elbow, is reflected by the measurements. From this study it can be concluded that, in 163 Labradors, the size of the osteophytes, rather then the morphology of the elbow joint, determines the outcome of the angle measurements and thus does not replace the OA-grading system as has been defined by the International Elbow Working Group that is widely in use.
Mandibular fracture repair in dogs and cats using epoxy resin and acrylic external skeletal fixation
Authors: Hobbs S. J. , Moores A. P. , Bennett D. , Carmichael S. , Owen M. R.
Published: March 2018

Mandibular fractures in 17 dogs and in eight cats were managed using external skeletal fixation (ESF) with acrylic or epoxy resin connecting bars. In order to maintain dental occlusion during fracture repair pha- ryngostomy or tracheostomy was performed in 12 dogs and in six cats to permit inhalational anaesthesia during surgery. All of the fractures healed with the exception of fractures in two dogs. Mandibular external skeletal fixation was well tolerated and there was not any evidence of iatrogenic damage to teeth nor to neurovascular structures within the mandible. Implant loosening was commonly observed at the time of fixator removal, but it did not affect the outcome.
The measurement of ground reaction force in dogs trotting on a treadmill
Authors: Valette J.-P. , Sanaa M. , Grandjean D. , Fanchon L.
Published: March 2018

We studied the time necessary to obtain reliable kinetic data from healthy dogs trotting on a treadmill. Ten adult male Malinois Belgian Shepherd dogs were made to trot on an instrumented treadmill to record the ground reaction force for the entire body and to determine the vertical force variables (peak [PFz], impulse [IFz], stride time [Str], peak time [Tz] and contact time [Ct]). Data were collected from each dog, during three sequences per day, on three consecutive days. In order to determine the contribution of the ‘sequence’, ‘day of measurement’, and ‘dog’ factors and the percentage of variance attributable to dogs, data were analyzed with a linear mixed model. The curve shapes were similar to those obtained with a floor-mounted force platform. Intra-dog coefficients of variation were between 1.57 and 3.46%. Inter-dog coefficients of variation were between 4.18 and 7.82%. A sequence effect was not noted. Each day had a significant effect on all of the data. All variables differed significantly from the first day compared to the other days. However there was not any difference between days 2 and 3. The percentage of the total variance attributable to dogs ranged from 37 to 88%. The coefficients of variation were lower than those obtained with common protocols. The treadmill locomotion remained consistent during a single session. Even if interday variation needs to be accounted for, reliable data can still be obtained after a single training session. The majority of the variation was attributable to the dog. An instrumented treadmill may be used for kinetic analysis.
Beta-tricalcium phosphate as a synthetic cancellous bone graft in veterinary orthopaedics
Authors: Díaz-Bertrana C. , Lafuente P. , Fontecha P. , Durall I. , Franch J.
Published: March 2018

The clinical use of β-tricalcium phosphate (β-TCP) as a synthetic cancellous bone graft in veterinary orthopaedics is herein reported. The retrospective study was based on 13 clinical cases belonging to 11 dogs and one cat. The weights of the dogs ranged from 3.4 to 48 kg. One female cat weighing 3.5 kg completed the study. The clinical cases were six arthrodeses (four carpal, two tarsal), one hypertrophic non-union (femur), one atrophic non-union (metacarpal bones) and five long-bone fractures (two femurs, one tibia, two radii) possessing subcritical-sized bone defects. The β-TCP used in this study was presented as irregular interconnected-porous granules and was placed in the bone defects after mixing it with fresh blood. Bone healing was achieved at between eight and 12 weeks in all clinical cases except for the case of the chronic atrophic nonunion in which only one of the four metacarpal bones healed. In the 12 successful cases, the bone defect grafted with β-TCP showed a radiological bone ingrowth of 100% (10 cases), 90% (one case) and 75% (one case). The complete lack of tissue adverse effects in our series, and the good defect healing, allows us to hypothesise that β-TCP can be successfully used as a synthetic bone graft in bone defects with good local biological conditions and where osteoconduction is especially needed for assuring a structural scaffold for newbone ingrowth. When, in addition to osteoconduction, osteoinduction and osteogenesis are necessary for defect healing, the fresh cancellous bone graft remains the gold standard in veterinary orthopaedics.
The effects of wire diameter and an additional lateral wire on pin and tension-band fixation subjected to cyclic loads
Authors: Kowaleski M. P. , Litsky A. S. , Boudrieau R. J. , Neat B.
Published: March 2018

Despite reports of frequent complications, pin and tension-band wire remains the most common repair of simple olecranon fractures and osteotomies (1–5). A recent mechanical study found wire diameter to be the key determinant of pin and tension-band construct strength; models with 1.25-mm wire were much stronger than those with standard 1.0-mm wire exposed to single loads to failure (6). Additionally, fixation strength was also increased when a lateral wire was used in combination with a standard figure-ofeight wire. The purpose of the present study was to assess any advantages provided by 1.25-mm wire or an additional lateral wire over 1.0-mm wire for pin and tension-band fixation subjected to cyclic loading. Pin and tension-band fixation was applied to plastic olecranon osteotomy models with three wire configurations: 1.0-mm figure-of-eight, 1.25-mm figure-of-eight, and combined 1.0-mm figure-of-eight and lateral. Cyclic load was applied while caudal osteotomy displacement was measured with an extensometer. The three groups were compared in terms of cycles to failure, mean minimum displacement, mean maximum displacement, and mean displacement per cycle. Models with an additional lateral wire survived significantly more cycles than those with a solitary 1.0-mm figure-of-eight wire, although caudal osteotomy displacements were not significantly different. Conversely, models with 1.25-mm wire allowed significantly smaller minimum and maximum displacements than those with 1.0-mm wire, but did not survive significantly more cycles. It therefore appears that clinical use of 1.25-mm wire may improve stability, while use of an additional lateral wire may improve durability.
Morphological and functional evaluation of a dog with dimelia
Authors: Blevins W. E. , Breur G. J. , Kim J.
Published: March 2018

Weight bearing patterns were investigated on a young Cocker Spaniel with dimelia (mirror hand) of the left forelimb, using a pressure sensing walkway (PS walkway). The dog had two left forelimb paws, both originating from the carpus, with symmetrical duplication of metacarpal bones and phalanges. In addition, the left radial head was subluxated and asynchronous growth of the left radius and ulna was noted. The PS walkway demonstrated minimal weight-bearing of the extra (medial) paw and longer metacarpal pad contact of the affected limb. The radiographic changes and the weight-bearing pattern during gait suggested that more weight was loaded on the lateral paw of the affected limb. Treatment was not recommended because of the relatively good limb function and the absence of overt pain. This is the first reported case of canine dimelia and foot pressure patterns in a canine congenital musculoskeletal deformity.
Editorial
Authors: Sumner-Smith G.
Published: March 2018

Emeritus Professor Wade O. Brinker, DVM, MS, Diplomate - American College of Veterinary Surgeons whose eightieth birthday took place on the 10th of October, 1992.
Radiographic Evaluation and Comparison of Plate Fixation after Triple Pelvic Osteotomy in 32 Dogs with Hip Dysplasia
Authors: Hazewinkel H. A. W. , Nap R.C. , Meij B.P. , Wolvekamp W. Th. C. , Koch D. A.
Published: March 2018

Triple pelvic osteotomy (TPO), as a treatment for canine hip dysplasia, was evaluated radiographically in 38 cases. Several parameters on radio-graphs of the pelvis, taken pre- and postoperatively, as well as six weeks and three months after the operation, were measured and compared. The results were also compared between iliac osteotomy fixation with the canine pelvic osteotomy plate (CPOP, n = 16) and the twisted dynamic compression plate (DCP, n = 22). Acetabular support (from 0.21 to 0.89), Norberg angle (from 77.6° to 111.8°) and hip joint congruence improved significantly after TPO. Dorsal pelvic width did not change, whereas, due to rotation, ventral pelvic width decreased to 80% of its pre-operative value. Osteophyte formation was judged to be moderate three months after the operation. Comparison of the two plating methods showed significant postoperative advantages for the CPO P group in terms of a higher Norberg angle and a better congruence. There was some loosening of 33% of the screws in both groups, but this did not interfere with the aim of the TP O procedure.

The effect of triple pelvic osteotomy, as a treatment for canine hip dysplasia, was investigated retrospectively by means of radiographs. Acetabular support, the Norberg angle, and hip joint congruence improved significantly after the operation. Iliac osteotomy fixation, with the canine pelvic osteotomy plate, displayed advantages over the twisted dynamic compression plate. Screw loosening occurred frequently but without any major consequences.
Implant Complications in 20 Triple Pelvic Osteotomies
Authors: Fries Cindy , Remedios Audrey
Published: March 2018

In 12 dogs with hip dysplasia, 20 triple pelvic osteotomies (eight bilateral and four unilateral) were performed. Screw loosening, occurring in six of 12 dogs (seven of 20 osteotomies), was the most common complication after surgery. Implants loosened from the cranial ilium in six hemipelvises (30%) and from both fragments in one hemipelvis, two to six weeks (mean — three) after the operation. Medial acetabular displace-ment caused pelvic narrowing (6 to 9%, mean = 8%) in three of four dogs. Medial ischial displacement decreased pelvic diameter (11 to 21%, mean = 17%) in four of seven osteotomies. All of the dogs with implant failure were treated conservatively with cage rest and in two cases Ehmer slings were used. Although none were lame, gait abnormalities were evident in three of seven dogs on follow-up examinations four to 12 months (mean = six) later.

Screw loosening, occurring in seven of 20 hemipelvises, was the most common postoperative complication associated with triple pelvic osteotomy. Fixation failures were managed conservatively. Despite decreased pelvic diameter in four of seven animals, none were lame or showed signs of pelvic obstruction at follow-up examinations four to 12 months later.
Clinical Case Applications of Mitek® Tissue Anchors in Veterinary Orthopaedics
Authors: Taylor R. A. , Franceschi Ruth A. , Edwards M. R.
Published: March 2018

The Mitek®a tissue anchor is a new device designed for reattaching avulsed tendons, ligaments and joint capsule to bone. This device has proven useful in human orthopaedics. Initially approved for use in Bankart repair (reattachment of glenohumeral ligament to anterior glenoid rim) procedures (1-3), the Mitek® anchor is now utilized in ligamentous repairs and tenodesis of the foot, ankle (4, 5) and wrist (6, 7). These devices have the advantages of biocompatibility, small size, impressive pullout strength, versatility and ease of application (8). In this study Mitek® anchors were used to repair avulsed or ruptured tarsal and phalangeal collateral ligaments, coxofemoral luxations and to provide stability to cruciate deficient stifles.

This paper describes the use of Metek® tissue anchors to repair tendinous, ligamentous, and joint capsule ruptures and avulsions.
Does Fracture Pattern Influence Thoracic Trauma?
Authors: Dyce J. , Houlton J. E. F.
Published: March 2018

The case records of 300 dogs presented for fracture repair following road traffic accident (RTA) or other trauma were studied to determine possible relationships between specific patterns of skeletal trauma and the prevalence of thoracic wall and pulmonary injury.

A significantly greater proportion of dogs involved in RTA (31%) sustained thoracic trauma compared ro those injured by other means (2.4%). Although RTA cases were more likely to suffer multiple fractures (23%), there was no significant relationship between the incidence and distribution of a fracture(s) and radiographic evidence of thoracic trauma.

Of those dogs with thoracic trauma, pneumothorax and pulmonary contusion were the most frequent injuries; more than one type of injury occurred in 43% of these cases.

Clinical management was altered as a result of thoracic injury in 24% of these cases.

In a retrospective survey of 300 dogs presented for fracture repair, there was no significant relationship between fracture pattern and the prevalence of thoracic trauma. Following road traffic accident, radio-graphic examination revealed thoracic trauma in 31% of dogs. Clinical management was modified as a result of thoracic injury in 24% of cases.
Fragmented Coronoid Process Associated with Premature Distal Radial Physeal Closure in Four Dogs
Authors: Lewis D.D. , Johnson K.A. , Allen G.S. , Yovich Jane , Macpherson G. C.
Published: March 2018

Fragmented coronoid process occurred in four dogs with humeroradial subluxation secondary to premature closure of the distal radial physis. The medial coronoid process was affected in three dogs but in the fourth dog a single osteochondral fragment was located between the medial and lateral coronoid processes. One dog was treated by medial arthrotomy and lengthening of the radius. In three dogs the fragment was removed via a lateral arthrotomy accomplished by proximal ulnar diaphyseal osteotomy and the ulna was shortened at the ulnar osteotomy site to provide congruity of the proximal radio-ulnar and humeroradial articulations. The longterm clinical results were encouraging. The role of mechanical loading on the coronoid process in the pathogenesis of these cases is discussed.

Four mature dogs were found to have fragmented coronoid process and humeroradial subluxation secondary to premature closure of the distal radial physis.

It is proposed that the humero-radial subluxation placed ab-normal mechanical stress on the coronoid process of the ulna and caused its fracture or fragmentation.
Treatment of Complicated Femoral Fractures With External Skeletal Fixation Utilizing Bone Screws and Polymethylmethacrylate
Authors: Kern D. A. , Johnston S. A. , Dew T. L.
Published: March 2018

Two femoral fractures initially treated using ASIF methods failed to proceed to union prior to implant loosening. The Inoue method of external skeletal fixation (ESF) employing AO/ASIF screws for fracture fragment fixation, a polymethylmethacrylate (PMMA) side bar and cancellous bone grafting was used. The dogs retained good limb function while the external fixators were in place. In case # 1 the fracture proceeded to union without further complications. The dog in case # 2 maintained good limb function, however fixation screw failure occurred prior to complete fracture healing.
Epidurography as a Diagnostic Aid in Canine Lumbosacral Compressive Disease: 47 Cases(1981–1986)
Authors: Chambers J. N. , Schwensen K. , Mahaffey M. B. , Selcer Barbara A.
Published: March 2018

Epidurograms were performed on 47 dogs with clinical signs consistent with lumbosacral compressive disease. Thirtyeight abnormal epidurograms were identified. Epidurograms were considered abnormal when complete obstruction of cranial forward flow or dorsal deviation over the lumbosacral junction were present. Dorsal laminectomies were performed on 28 dogs with abnormal epidurographic findings. Surgical findings included: disc herniation (17), connective tissue nerve root entrapment (5), fibrous connective tissue mass (3), no abnormality (2), and instability (1). The strong correlation between abnormal epidurographic signs and compressive lumbosacral lesions seen at surgery (93%) suggests that epidurography can be a valuable aid in the diagnosis of lumbosacral compressive lesions.
A Suggested Fracture Classification of Adult Small Animal Fractures
Authors: Prieur W. D. , Braden T. D. , v. Rechenberg Brigitte
Published: March 2018

A classification system for fractures of long bones in adult small animals is described. Its application is demonstrated in some femur fractures. This classification system will be expanded later on to other bones like pelvis, spine, distal limb bones, and to fractures of the growing animals.
The Adjunctive Use of Half-Pin (Type I) External Skeletal Fixators in Combination with Intramedullary Pins for Femoral Fracture Fixation
Authors: Schwarz P. D. , Salman M. D. , Foland Melissa
Published: March 2018

A half-pin (type I) external skeletal fixator was used in conjunction with an intramedullary pin(s) for management of 29 femur fractures in 15 dogs and 14 cats. Eighty percent of the dogs and 100% of the cats achieved bony union using this combination of implants. However, because of the development of major complications which permanently impaired limb function (e.g. quadriceps tie-down), only 67% of the dogs and 93% of the cats were considered to have successful outcomes. The overall complication rate was 87% for dogs and 43% for cats. Dogs weighing <6.8 kg had a significantly lower complication rate than dogs weighing ≥6.8 kg. Dogs < one year of age were significantly more likely to develop a major complication resulting in an unsuccessful outcome, than dogs ≥ one year of age. A significant association was not established between any of the study variables and the complication incidence in cats.
Entwicklung und Umsetzung eines integrierten Versorgungsprojektes aus der Sicht eines Trägers
Authors: Steckermaier H.
Published: March 2018

Die Integrierte Versorgung nach § 140 a ff SGB V erhält auch in der psychiatrischen Versorgungslandschaft zunehmend Relevanz. Gemessen an der Patientenzahl, kann das von der Techniker Krankenkasse (TK) initiierte “NetzWerk psychische Gesundheit” (NWpG) als deutschlandweit eines der größten integrierten Versorgungsprojekte im psychiatrischen Bereich bezeichnet werden. Seit langem geforderte Versorgungsangebote wie “Hometreatment” oder “Rückzugsräume” können damit erstmals nachhaltig und integriert realisiert werden.

Für die Vertragspartner der TK – überwiegend Gemeindepsychiatrische Träger – ergeben sich jedoch neuartige Herausforderungen zur Umsetzung dieses Projektes. Neben den geringen Erfahrungswerten mit einer populationsorientierten integrierten Versorgung und einer auf einem Capitationsystem basierenden Finanzierungslogik, sind neue Herausforderungen in der praktischen Patientenarbeit zu bewältigen.

Für Gemeindepsychiatrische Träger eröffnen sich dennoch vielfältige Möglichkeiten, jahrzehntelange Forderungen nach einer bedürfnisorientierten ambulant aufsuchenden Versorgung umzusetzen und die weitere gemeindepsychiatrische Entwicklung aktiv mitzugestalten.
Stabiler Verlauf einer hochaktiven schubförmigen MS unter Natalizumab seit mehr als 4 Jahren
Authors: Meuth S. , Ruck T.
Published: March 2018

Gegenstand und Ziel: Anhand eines Fallberichtes einer Patientin mit einer hochaktiven schubförmigen Multiplen Sklerose, deren Erkrankung unter einer Langzeittherapie mit Natalizumab anhaltend stabilisiert werden konnte, sollen die Überlegungen zu Nutzen und Risiken der Natalizumabtherapie verdeutlicht werden. Material und Methoden: Dem Fallbericht werden Anamnese, klinische Befunde sowie MRT-Aufnahmen zugrunde gelegt. Ergebnisse: Unter der Therapie mit Natalizumab konnte eine anhaltende Stabilisierung des Krankheitsverlaufes ohne klinische und paraklinische Krankheitsaktivität über den Zeitraum von 54 Infusionszyklen erreicht werden. Bis auf nicht behandlungsbedürftige Infektionskrankheiten konnten keine schweren Nebenwirkungen eruiert werden. Schlussfolgerungen/klinische Relevanz: Eine langjährige Therapie mit Natalizumab, über 24 Monate hinweg, ist abhängig vom initialen Krankheitsverlauf, dem Ansprechen auf die Therapie, der Risikostratifzierung einer PML und dem individuellen Patientenwunsch auch trotz erhöhter Risiken zu erwägen.
Methods for Predictor Analysis of Repeated Measurements: Application to Psychiatric Data
Authors: Eisenacher M. , Riesbeck M. , Gaebel W. , Köpcke W. , Seuchter S. A. ,   and other members of the A.N.I. Study Group
Published: March 2018

Objectives:
In schizophrenia research, little attention yet has been directed on methods for analyzing data from studies with repeated measurements over time. Motivation for this research stems from a project within the German Research Network on Schizophrenia, in which an algorithm is developed to guide prodrome-based early intervention strategies in stable first episode patients.

Methods:
We present two different approaches for the analysis of correlated response data, the Generalized Estimating Equations (GEE) method and the Artificial Neural Network (ANN) approach. We illustrate the methods using the data of the A.N.I. study, which is one of the largest German multicenter treatment studies in regard to the long-term treatment of schizophrenia conducted between 1983 and 1989.

Results:
The results of statistical model selection prior to GEE analysis and various data presentation methods for ANNs are presented. The primary goal of our evaluation is to investigate if the defined prodromes are valid predictors for relapse. Additionally, it is shown that both methods are applicable on a realistic data set.

Conclusions:
It is concluded that both methods are suitable for predictor analysis especially since all variable time points of the patients are included instead of only selected, so that it can be assumed that results are not biased. With the GEE method a test of association for each predictor can be performed whereas with ANNs a general proposition can be made for pro-dromes depending on the type of data presentation. Using the A.N.I. data the prodrome ‘trouble sleeping’ seems to be the most informative predictor. Finally, the important differences of the two methods are discussed.
Forecasting of Life Threatening Arrhythmias Using the Compression Entropy of Heart Rate
Authors: Baumert M. , Baier V. , Haueisen J. , Wessel N. , Meyerfeldt U. , Schirdewan A. , Voss A.
Published: March 2018

Objectives:
Ventricular tachycardia (VT) provoking sudden cardiac death (SCD) are a major cause of mortality in the developed countries. The most efficient therapy for SCD prevention are implantable cardioverter defibrillators (ICD). In this study heart rate variability (HRV) measures were analyzed for short-term forecasting of VT in order to improve VT sensing and to enable a patient warning of forthcoming shocks.

Methods:
The last 1000 normal beat-to-beat intervals before 50 VT episodes stored by the ICD were analyzed and compared to individually acquired control time series (CON). HRV analysis was performed with standard parameters of time and frequency domain as suggested by the HRV Task Force and furthermore with a newly developed and optimized nonlinear parameter that assesses the compression entropy of heart rate (Hc).

Results:
Except of meanNN (p = 0.02) we found no significant differences in standard HRV parameters. In contrast, Hc revealed highly significant (p = 0.007) alterations in VT compared with CON suggesting a decreased complexity before the onset of VT.

Conclusion:
Compression entropy might be a suitable parameter for short-term forecasting of life-threatening tachycardia in ICD.
An Inventory of Evaluation Studies of Information Technology in Health Care
Authors: de Keizer N. , Ammenwerth E.
Published: March 2018

Objectives:
During the last years the significance of evaluation studies as well as the interest in adequate methods and approaches for evaluation has grown in medical informatics. In order to put this discussion into historical perspective of evaluation research, we conducted a systematic review on trends in evaluation research of information technology in health care from 1982 to 2002.

Methods:
The inventory is based on a systematic literature search in PubMed. Abstracts were included when they described an evaluation study of a computer-based component in health care. We identified 1035 papers from 1982 to 2002 and indexed them based on a multi-axial classification describing type of information system, study location, evaluation strategy, evaluation methods, evaluation setting, and evaluation focus.

Results and Conclusions:
We found interesting developments in evaluation research in the last 20 years. For example, there has been a strong shift from medical journals to medical informatics journals. With regard to methods, explanatory research and quantitative methods have dominated evaluation studies in the last 20 years. Since 1982, the number of lab studies and technical evaluation studies has declined, while the number of studies focusing on the influence of information technology on quality of care processes or outcome of patient care has increased. We interpret this shift as a sign of maturation of evaluation research in medical informatics.
The EpiLink Record Linkage Software
Authors: Tittarelli A. , Tagliabue G. , Maghini A. , Fabiano S. , Crosignani P. , Tessandori R. , Contiero P.
Published: March 2018

Objectives:
Record linkage, the process of bringing together separately compiled but related records from different databases, is essential in many areas of biomedical research. We developed a record linkage program (EpiLink), which employs a simple mathematical approach. We describe the program and present results obtained testing it in a linkage task.

Methods:
EpiLink was designed to be flexible with user-friendly settings to tailor linkage and operating parameters to specific linkage tasks, and employ deterministic, probabilistic or sequential deterministic-probabilistic linkage strategies as required. The user can also standardize data format, examine linkage results and accept or discard them. We used EpiLink to link a subset of cases of the Lombardy Cancer Registry (20,724 records) with the Social Security file of the population (1,021,846 records) covered by the registry. The linkage strategy was deterministic, followed by several probabilistic linkage steps.

Results:
Manual inspection of the results showed that EpiLink achieved 98.8% specificity and 96.5% sensitivity.

Conclusions:
EpiLink is a practical and accurate means of linking records from different databases that can be used by non-statisticians and is efficient in terms of human and financial resources.
Time-variant Parametric Estimation of Transient Quadratic Phase Couplings during Electroencephalographic Burst Activity
Authors: Eiselt M. , Schelenz C. , Witte H. , Schwab K.
Published: March 2018

Objectives:
Electroencephalographic burst activity characteristic of burst-suppression pattern (BSP) in sedated patients and of burst-interburst pattern (BIP) in the quiet sleep of healthy neonates have similar linear and non-linear signal properties. Strong interrelations between a slow frequency component and rhythmic, spindle-like activities with higher frequencies have been identified in previous studies. Time-varying characteristics of BSP and BIP prevent a definite pattern-related analysis. A continuous estimation of the bispectrum is essential to analyze these patterns. Parametric bispectral approaches provide this opportunity.

Methods:
The adaptation of an AR model leads to a parametric bispectrum by using the transfer function of the estimated AR filter. Time-variant parametric bispectral approaches require an estimation of AR parameters which consider higher order moments to preserve phase information. Accordingly, a time-variant parametric estimation of the bispectrum was introduced. Data driven simulations were performed to provide optimal parameters. BSP (12 patients) and BIP (6 neonates) were analyzed using this novel approach.

Results:
Significant differences in the time course of burst pattern during BSP and burst-like pattern before the onset of BSP could be shown. A rhythmic quadratic phase coupling (period 10 sec) was identified during BIP in all neonates.

Conclusion:
Quadratic phase couplings during BSP increases in the time course depending on depth of sedation. The visually detected burst activity in BIP is only the temporarily observable EEG correlate of a hidden neural process. Time-variant bispectral approaches offer the possibility of a better characterization of underlying neural processes leading to improved diagnostic tools used in clinical routine.
Sample Selection for Microarray Gene Expression Studies
Authors: Repsilber D. , Fink L. , Jacobsen M. , Bläsing O. , Ziegler A.
Published: March 2018

Objectives:
The choice of biomedical samples for microarray gene expression studies is decisive for both validity and interpretability of results. We present a consistent, comprehensive framework to deal with the typical selection problems in microarray studies.

Methods:
Microarray studies are designed either as case-control studies or as comparisons of parallel groups from cohort studies, since high levels of random variation in the experimental approach thwart absolute measurements of gene expression levels. Validity and results of gene expression studies heavily rely on the appropriate choice of these study groups. Therefore, the so-called principles of comparability, which are well known from both clinical and epidemiological studies, need to be applied to microarray experiments.

Results:
The principles of comparability are the study-base principle, the principle of deconfounding and the principle of comparable accuracy in measurements. We explain each of these principles, show how they apply to microarray experiments, and illustrate them with examples. The examples are chosen as to represent typical stumbling blocks of microarray experimental design, and to exemplify the benefits of implementing the principles of comparability in the setting of micro-array experiments.

Conclusions:
Microarray studies are closely related to classical study designs and therefore have to obey the same principles of comparability as these. Their validity should not be compromised by selection, confounding or information bias. The so-called study-base principle, calling for comparability and thorough definition of the compared cell populations, is the key principle for the choice of biomedical samples and controls in microarray studies.
Are Structured Data Structured Identically?
Authors: Roukema J. , van Ginneken A. M. , de Wilde M. , van der Lei J. , Los R. K.
Published: March 2018

Objective:
OpenSDE is an application that supports structured recording of narrative patient data to enable use of the data in both clinical practice and clinical research. Reliability and accuracy of collected data are essential for subsequent data use. In this study we analyze the uniformity of data entered with OpenSDE. Our objective is to obtain insight into the consensus and differences of recorded data.

Methods:
Three pediatricians transcribed 20 paper patient records using OpenSDE. The transcribed records were compared and all recorded findings were classified into one of six categories of difference.

Results:
Of all findings 22% were recorded identically; 17% of the findings were recorded differently (predominantly as free text); 61% was omitted, inferred, or in conflict with the paper record.

Conclusion:
The results of this study show that recording patient data using structured data entry does not necessarily lead to uniformly structured data.
Identification of Adverse Drug Reactions by Evaluation of a Prescription Database, Demonstrated for “Risk of Bleeding”
Authors: Westendorf J. , Diebow R. , Kieser M. , Gaus W.
Published: March 2018

Objective:
Information about adverse drug reactions plays an important role when assessing the benefit/risk profile of a drug. Identifying rare adverse drug reactions, however, is a difficult task. This paper illustrates the advantages of using a prescription database for this purpose.

Methods:
The mediplus® database used in our analysis covered data from 320,644 outpatients observed between July 1999 and June 2002. The example of bleeding complications during intake of antidementia drugs is used to illustrate this approach. The comparison of cohorts and subgroups is nearly always a problem in surveys. For our analyses we considered a set of patients who had taken a selected medication for a certain period of time and compared the frequency of adverse events with those occurring when the same patients did not take this medication. Hence, the comparison with versus without a certain medication is based on the same set of patients as in a cross-over study.

Results:
Our evaluations indicate that the rate of bleeding complications is low when taking any of the widely used antidementia drugs, glutamate modulators, cholinesterase inhibitors, calcium antagonists or the phytomedicine Ginkgo biloba.

Conclusion:
Basing the comparison of the rates of complications during periods with and without intake of a certain drug on the same set of patients may be a useful tool for assessing adverse drug reactions from data reported in prescription databases.
Medical Image Quality as a Socio-technical Phenomenon
Authors: Edwin B. , Mårvik R. , Aanestad M.
Published: March 2018

Objectives: The study aims to interpret image quality in laparoscopic surgery not only as a technical parameter but also as the result of the situation of use.

Methods: Observational studies of laparoscopy in use, semi-structured and informal interviews with laparoscopists.

Results: When medical images are digitized to exploit novel technical possibilities, image quality becomes a paramount issue. Image quality is often discussed exclusively in technical terms, but the socio-technical study of image quality in surgical telemedicine presented in this paper showed that it is definitely more than a purely technical parameter.

Conclusions: While the resulting quality of the image was significantly shaped by the persons involved, the concept of “quality” itself was also relative and changing with the situation of use. A given technology does not determine image quality. Rather than focusing only on the technical quality, the attention of designers and decision makers should also be directed to the socio-technical network surrounding the image and its use.