bluuebunny/crossref_metadata_2025 huggingface dataset:
The versatile reverse flow sural artery neurocutaneous flap: A case series and review of literature
Authors: Ahmed Syed Kamran , Fung Boris Kwok Keung , Ip Wing Yuk , Fok Margaret , Chow Shew Ping
Published: April 2008

Background

Reverse flow sural neurocutaneous flap has been utilized more frequently during the past decade to cover vital structures around the foot and ankle area. The potential advantages are the relatively constant blood supply, ease of elevation and preservation of major vascular trunks in the leg. The potential disadvantages remain venous congestion, donor site morbidity and lack of sensation.

Methods

This descriptive case series was conducted at Queen Mary Hospital, Hong Kong, from 1997 to 2003. Ten patients having undergone reverse flow sural neurocutaneous flap were identified through medical records. There were six females (60%) and four males (40%), with an average age of 59.8 years. The defects occurred as a result of trauma in five patients (50%), diabetic ulcers in four (40%) and decubitus ulcer in one (10%) paraplegic patient. The defect site included non weight bearing heel in four (40%), tendo Achilles in two (20%), distal tibia in two (20%), lateral malleolus in one (10%) and medial aspect of the midfoot in one patient (10%). The maximum flap size harvested was 14 × 6 cm. Preoperative doppler evaluation was performed in all patients to identify perforators and modified plaster of paris boot was used in the post operative period. A detailed questionnaire was developed addressing variables of interest.

Results

There was no flap failure. Venous congestion was encountered in one case. The donor site was relatively unsightly but acceptable to all patients. The loss of sensation in the sural nerve distribution was transient in all patients.

Conclusion

Reverse sural artery flap remains to be the workhorse flap to resurface the soft tissue defects of the foot and ankle. Anastomosis of the sural nerve to the digital plantar nerve can potentially solve the issue of lack of sensation in the flap especially when used for weight bearing heel.
Late pulmonary metastases of renal cell carcinoma immediately after post-transplantation immunosuppressive treatment: a case report
Authors: Cozar Jose Manuel , Aptsiauri Natalia , Tallada Miguel , Garrido Federico , Ruiz-Cabello Francisco
Published: April 2008

Introduction

We report a case of pulmonary metastatic recurrence of renal adenocarcinoma soon after radical nephrectomy that was followed by renal transplant and immunosuppressive medication. Increased risk of metastatic recurrence of renal cell carcinoma should be considered in the immediate post-transplant period when immunosuppressive medication is administered, even if nephrectomy had been performed many years earlier.

Case presentation

In 1986 the patient demonstrated renal insufficiency secondary to mesangial glomerulonephritis. In 1992 he underwent left side radical nephrectomy with histopathological diagnosis of clear cell adenocarcinoma. Mesangial glomerulonephritis in the remaining right kidney progressed to end-stage renal failure. In October 2000 he received a kidney transplant from a cadaver and commenced immunosuppressive medication. Two months later, several nodules were found in his lungs, which were identified as metastases from the primary renal tumor that had been removed with the diseased kidney 8 years earlier.

Conclusion

Recurrence of renal cell carcinoma metastases points to tumor dormancy and reflects a misbalance between effective tumor immune surveillance and immune escape. This case demonstrates that a state of tumor dormancy can be interrupted soon after administration of immunosuppressant medication.
Mannosylated self-peptide inhibits the development of experimental autoimmune encephalomyelitis via expansion of nonencephalitogenic T cells
Authors: Kel Junda M , Slütter Bram , Drijfhout Jan Wouter , Koning Frits , Nagelkerken Lex
Published: April 2008

Tolerance to experimental autoimmune encephalomyelitis (EAE) in SJL mice can be induced by immunization with a mannosylated form of the proteolipid protein (M-PLP139–151), despite the presence of CFA. The state of tolerance is characterized by poor delayed-type hypersensitivity responses and the absence of clinical EAE symptoms. In vivo monitoring of CFSE-labeled PLP139–151-specific TCR-transgenic (5B6) T cells revealed that immunization with M-PLP139–151 increases the clonal expansion of 5B6 T cells that do not develop full effector functions. Moreover, nonfunctional T cells obtained from M-PLP139–151-immunized mice showed poor blastogenesis and were unable to transfer EAE to naïve recipients. Nevertheless, the in vitro production of cytokines and chemokines associated with EAE was unaffected. Importantly, tolerance induced by M-PLP139–151 was abrogated by the administration of pertussis toxin, resulting in EAE development. Our results suggest that M-PLP139–151 inhibits EAE development by affecting the differentiation of T cells into encephalitogenic effector cells.
Telemedicine support for the developing world
Authors: Wootton Richard
Published: April 2008

Summary

Telemedicine has been used for some years in the industrialized world, albeit with rather mixed success. There is also a considerable literature on the potential use of telemedicine for the developing world. However, there are few reports of the actual use of telemedicine there. A review identified five telemedicine networks providing second opinions; each network had been in operation for over five years. Although they have different aims and methods of operation, they exhibit some common features. In particular, none of them appear to be dealing with markedly increasing referral rates. Rough calculations suggest that only about 0.1% of the potential telemedicine demand from the developing world is being met. Possible reasons include the referrers being too busy and a perceived loss of control. If this analysis is correct, then the right strategy for future telemedicine in developing countries will be to concentrate on the construction of within-country networks that demonstrably alter health outcomes, can be shown to be cost-effective and sustainable, and will provide a model for other countries to copy.
Preliminary test of an Internet-based diabetes self-management tool
Authors: Armstrong Natalie , Powell John
Published: April 2008

Summary

Self-care is a way of helping the health service to manage the growth in long-term chronic conditions. We developed an Internet-based self-management tool for diabetes following detailed consultations with patients. The Virtual Clinic allows a patient to communicate with their health professionals, find information about their condition and share support and advice with others through peer-to-peer discussions. We conducted a test of the Virtual Clinic with five patients prior to the start of a six-month pilot study to evaluate its feasibility, acceptability and effectiveness. The test session involved an interactive computer-based element followed by a focus group to gather feedback. All five patients were positive about the Virtual Clinic. A user-centred approach to developing an Internet intervention is important to ensure that it will meet patients' needs and that they will be enthusiastic about using it.
PROSAFE-extended, a telemedicine platform to contribute to medical diagnosis
Authors: Bonhomme Sylvain , Campo Eric , Estève Daniel , Guennec Joëlle
Published: April 2008

Summary

A single elderly, dependent subject was monitored for a period of three months. Data were collected from 12 sensors in his apartment. We investigated new criteria for diagnosing abnormal events with more reliability. Initial results suggested that six diagnostic functions could be achieved using only presence sensors. These were: immobility detection; the level of agitation; the speed of motion in chosen areas; the distance covered; the time spent in given areas of the apartment; and the activities of getting up, going to bed and going to the toilet. The analysis was based on calculation of thresholds from past behaviour of the user for automatically defined temporal bands. Any variation in these criteria may represent a change in the subject's physical abilities and may thus allow the remote identification of potential risk.
E-health: implementation and evaluation research in Scotland – a scoping exercise
Authors: Clark Julia S , Mair Frances S , O'Donnell Catherine , Liu Joseph
Published: April 2008

Summary

We searched the National Research Register (NRR) to identify funded research in Scotland (or in collaboration with a Scottish partner) in the area of implementation and evaluation of e-health services. A total of 61 research projects were identified which had been funded since 1 January 1995. These projects shared almost £7 million of funding (£1 is $1.9 or €1.3), the main funding sources being the Scottish Government and the European Union. Based on the projects reviewed, the majority of e-health research in Scotland was being conducted within the communication systems domain. Most of the research was being conducted at a single centre: only 14 studies (23%) were multisite. Future collaboration between these researchers, involving larger scale funding bids, may increase the quantity of e-health implementation and evaluation research.
Early experience in using telemonitoring for the management of chronic disease in primary care
Authors: Fursse Joanna , Clarke Malcolm , Jones Russell , Khemka Sneh , Findlay Genevieve
Published: April 2008

Summary

We have investigated the use of telemonitoring in three long-term conditions: chronic heart failure (CHF), type 2 diabetes and essential hypertension. Participants were provided with a home telemonitoring unit for a 12-week period and entered physiological data each day. The data were sent automatically via the participant's telephone line to a server and could be viewed via a web browser. An intervention algorithm was developed to improve the accuracy with which patients requiring intervention were recognized compared to existing systems based on a simple threshold. Thirty patients completed the 12-week trial. One patient dropped out, giving data on 29 patients (mean age 70 years, 17 women). The algorithm prompted a clinical intervention in 11 patients (38%). The average time that elapsed before the first intervention was 47 days (SD 21). Primarily the interventions (72%) resulted in changes to medication and health advice. The results suggest that four weeks is sufficient time in which to recognize the need to intervene clinically and that in 12 weeks it is possible to effect a change towards a target.
Applying user-generated quality criteria to develop an Internet intervention for patients with heart disease
Authors: Kerr Cicely , Murray Elizabeth , Burns Jo , Turner Indra , Westwood Mark A , MacAdam Catherine , Nazareth Irwin , Patterson David
Published: April 2008

Summary

Internet interventions can help people to self-manage chronic disease. However, they are only likely to be used if they meet patients' perceived needs. We have developed an Internet intervention in two stages to meet the needs of patients with coronary heart disease (CHD). First, user-generated criteria were applied to an existing US-based intervention called ‘CHESS Living with Heart Disease’ which provides information, emotional and social support, self-assessment and monitoring tools, and behavioural change support. This identifed the development work required. Then we conducted a user evaluation with a panel of five patients with CHD. Overall, users generally made positive comments about the information content. However they were critical of presentation, ease of navigation through the content, understanding what was offered in the different services and finding the information they were after. Applying user-generated quality criteria proved useful in developing an intervention to meet the needs of UK patients with CHD.
More patients with minor injuries could be seen by telemedicine
Authors: Mair Fiona , Ferguson James
Published: April 2008

Summary

The Grampian Minor Injuries Telemedicine Service has been operating since 2001 supporting 15 minor injury units (MIUs) in community hospitals. Currently over 120 new patients are seen each month. We conducted a retrospective review to estimate the number of patients who were sent to the main hospital emergency department (ED) who would have been suitable for telemedicine treatment instead. All attendances at three MIUs and onward referrals to the ED during the months January and July 2006 were identified from a database. A total of 112 patients were referred from the three MIUs during the study period. MIU C, which utilized teleconsultations the most, referred the lowest proportion of its patients (2%). MIU B, which had all X-rays reviewed by a general practitioner, referred the most (85%). At MIU B, 80–85% of patients referred to the ED without having a teleconsultation could have been managed by telemedicine. Telemedicine for MIUs has been repeatedly reported in the medical literature as being successful, but widespread usage of this technique remains to be achieved.
Wireless-accessible sensor populations for monitoring biological variables
Authors: Mazzù Marco , Scalvini Simonetta , Giordano Amerigo , Frumento Enrico , Wells Hannah , Lokhorst Kees , Glisenti Fulvio
Published: April 2008

Summary

The current health-care infrastructure is generally considered to be inadequate to meet the needs of an increasingly older population. We have investigated the feasibility of a passive in-home monitoring system based on wireless accessible sensor populations (WASP). In an EU-funded project we have identified the system architecture and the sensors required to gather data from elderly patients by continuous monitoring. Data from biological variables (heart rate, accelerometers, body temperature and galvanic skin response) and everyday habits (body position, movements) will be transmitted to a central monitoring centre. A Body Sensor Network (worn by the patient and able to communicate with a personal mobile hub) and an Ambient Sensor Network (a number of wireless sensors incorporated into the patient's home) are envisaged. The system will be tested by using it in the telemedicine activities of the Health Telematic Network, which manages home help projects for elderly patients.
Diagnosis of congenital heart disease in neonates by videoconferencing: an eight-year experience
Authors: McCrossan Brian A , Grant Brian , Morgan Gareth J , Sands Andrew J , Craig Brian , Casey Frank A
Published: April 2008

Summary

Over an eight-year period, echocardiograms were transmitted by ISDN at 384 kbit/s for a total of 132 patients suspected of having congenital heart disease (CHD). Five transmitted scans were inadequate. Hands-on echocardiograms were performed subsequently on 116 of the remaining 127 cases (91%). Major CHD was diagnosed in 42 of the 116 infants (36%) and minor CHD in 49 (42%). The telemedicine diagnosis was accurate in 97% of the cases (kappa = 0.90). There were four diagnostic errors. Transfer to the regional unit was avoided in 95 patients (72%). The present study shows that high diagnostic accuracy is possible using a telemedicine link to transmit images obtained with the assistance of real-time guidance by a paediatric cardiologist. The results also demonstrate the importance of an expert interpreting the echocardiographic images, since the accuracy of diagnosis was considerably improved (the kappa coefficient increased from 0.14 to 0.90).
Home support for children with complex congenital heart disease using videoconferencing via broadband: initial results
Authors: McCrossan Brian A , Grant Brian , Morgan Gareth J , Sands Andrew J , Craig Brian , Casey Frank A
Published: April 2008

Summary

We originally developed a home support service for babies with complex congenital heart disease, in which videoconferencing was delivered via three ISDN lines. We have now investigated the feasibility of using broadband (Internet protocol) transmission instead of ISDN lines. Five patients were enrolled (age range 14–58 days) and 78 videoconferences were conducted over a six-month period. In 70 videoconferences (90%), a successful connection was established at the first attempt. In the last 56 videoconferences a connection bandwidth of 256 kbit/s was consistently achieved. The clinician's opinions of the videoconferences were good. Parental opinions on the videoconferences were very high. There was also a significant reduction in parental anxiety following the video consultations: the median reduction in the STAI score was 6 points ( P < 0.05) ( n = 78). Home support for infants or children with complex congenital heart disease can be provided successfully by video consultations utilizing home broadband links.
The delivery of a minor injuries telemedicine service by Emergency Nurse Practitioners
Authors: Miller David R , Alam Khyber , Fraser Susan , Ferguson James
Published: April 2008

Summary

We conducted a retrospective review to assess the potential for Emergency Nurse Practitioners (ENPs) to deliver telemedicine advice for minor injuries. Over a one-year study period, 835 patients from 15 minor injury units in community hospitals presented to the minor injuries telemedicine service and were seen via videoconferencing by a doctor at the Aberdeen emergency department. A case review showed that overall, ENPs were considered capable of treating 470 of 788 new presentations (60%). If children under 14 years of age and shoulder injuries were excluded, this figure rose to 84%. Assessment of all minor injuries via a telemedicine network by medical staff is unnecessary. An ENP-led service offers a realistic and attractive alternative.
Characteristics of radio medical advice to fishing vessels in Scottish coastal waters
Authors: Mitchelson Mark A , Ferguson James , Armes Roland , Page J Graham
Published: April 2008

Summary

We examined the emergencies arising on fishing vessels in Scottish Coastal Waters which required ship-to-shore radio medical advice. All calls to the service were identified for the 12-month period from August 2005. A total of 186 calls were received; 38% of calls were from fishing vessels. During the study period 53% of the calls were trauma-related, while 47% were medical emergencies. Our data suggest that there are many fishermen working offshore with chronic medical conditions. Overall, 85% of calls from fishing vessels resulted in evacuation as the outcome. Improved occupational health screening, compliance with health and safety legislation, and an evidence-based approach to remote medical care may improve seafarer self-care and reduce emergency evacuations.
A pilot study of mobile phone-based therapy for obese patients
Authors: Morak Juergen , Schindler Karin , Goerzer Evelin , Kastner Peter , Toplak Hermann , Ludvik Bernhard , Schreier Guenter
Published: April 2008

Summary

We conducted a pilot study to assess the feasibility of a web-based therapy management system with mobile phone access to support obese patients. A total of 25 patients participated in the study. The mean age of the patients was 48 years. The mean body mass index of the patients at recruitment was 35.6 kg/m2. The mean observation period was 70 days. A total of 361 successful data transmissions was performed — the mean number of transmissions per patient was 14. The total number of outgoing reminder messages was 123, corresponding to 4.9 reminder messages per patient. At the end of the study, there were significant reductions of 2.4 cm in abdominal girth ( P < 0.001), 2.4 kg in bodyweight ( P < 0.001) and 0.78 kg/m2 in body mass index ( P < 0.001). In a questionnaire at the end of the study, the majority of the participants gave answers that indicated a positive attitude towards the system. The pilot study showed that mobile phones can be utilized as patient terminals for therapy in patients suffering from obesity.
Using Personal Digital Assistants to improve self-care in oral health
Authors: O'Hara David M , Seagriff-Curtin Patricia , Levitz Mitchell , Davies Daniel , Stock Steven
Published: April 2008

Summary

We conducted a pilot project to evaluate the potential of Personal Digital Assistant (PDA) technologies to improve the oral health of people with mild to moderate intellectual disabilities, chronic health problems and a long-standing history of poor oral health self-care. Oral health video and audio materials were prepared and transferred to PDAs. Patients were trained in the use of the PDAs at a regular dental appointment and the utilization of the PDA and any change in oral health status was tracked over the next six months. More than half of the 36 patients reported problems in keeping the PDAs functioning properly (mainly problems of keeping the batteries charged) for the duration of the project and 11 patients dropped out of the study. Ten of the remainder (40%) achieved improvement in at least three areas of oral health. The pilot project potentially brings a range of health promotion activities within the reach of people with limited health literacy which may produce better self-management of chronic health conditions.
Clinical validation of a wearable system for emotional recognition based on biosignals
Authors: Pastor-Sanz Laura , Vera-Munoz Cecilia , Fico Giuseppe , Arredondo María Teresa
Published: April 2008

Summary

The AUBADE system can be trained to classify a subject's feelings into six different emotional classes, derived from three of the basic emotions (happiness, disgust and fear). The performance of different classifiers was examined. Biosignals were recorded from 24 healthy subjects who viewed pictures designed to invoke different emotional responses. A psychologist evaluated the emotional status of the subjects by looking at their faces. During the training stage, information from 15 subjects was used to teach the system how to discriminate the emotional status of the subject based on the biosignals provided as input. A subset of the data was used for comparing the performance of four different classifiers. They were evaluated using three different metrics: sensitivity, positive predictive accuracy and accuracy. Using the SVM classifier, the AUBADE system provided sensitivities in the range 63–81%. The positive predictive accuracy was in the range 71–95%. The accuracy was in the range 63–83%, depending on the emotional class considered. The work paves the way for remote telemonitoring of patients suffering from neurological diseases.
A systematic review of networked technologies supporting carers of people with dementia
Authors: Powell John , Chiu Teresa , Eysenbach Gunther
Published: April 2008

Summary

We conducted a systematic review of the effectiveness of networked ICT interventions in supporting carers of people with dementia. Five bibliographic databases were searched and a total of 1456 abstracts were identified as potentially relevant. From these we identified 15 papers describing five interventions: ComputerLink, AlzOnline, Caring for Others and two studies from the REACH project (TLC and CTIS). The interventions reviewed were multifaceted with elements of networked peer support. Outcomes were inconsistent but suggested that the interventions had moderate effects on improving carer stress and depression. Treatment effects were found to vary with caregiver characteristics such as ethnic groups, formal support and baseline burden. Further evaluation is needed in robust trials with good follow-up.
Provision of telehealth to the Scottish Police College
Authors: Webster Karyn , Fraser Susan , Mair Fiona , Ferguson James
Published: April 2008

Summary

A telemedicine service was established for the Scottish Police College with medical advice provided from the Aberdeen Royal Infirmary. Use of the service from November 2004 to February 2006 was audited. A total of 192 patients presented to the service during the 16-month study period. There were 97 teleconsultations. The remaining 95 patients (49%) were not seen by telemedicine due to technical problems. The complaints dealt with were 68% injuries and 32% minor illness ( n = 97). The outcome of the teleconsultation was: advice alone 76%; referral to a general practitioner 10%; and A&E referral 14% ( n = 97). The treatment advised was: over-the-counter medicine 85%; prescription 5%; and nil 10% ( n = 97). Even with a 24% connection rate, the service overall was perceived as beneficial and the Police College wished to continue to use the service, if the technology difficulties could be resolved.
A low-cost decision support network for electrocardiograph transmission from oil rigs in the North Sea
Authors: Webster Karyn , Fraser Susan , Mair Fiona , Ferguson James
Published: April 2008

Summary

A telemedicine service consisting of electrocardiogram (ECG) interpretation and advice on the management of chest pain offshore was offered to oil rig installations in the North Sea. A total of 14 subscribing oil rigs were supplied with thrombolytic drugs and rig paramedics were trained in their delivery. Electrocardiographs could be recorded using a standard ECG machine and then digitized using a scanner for transmission as an email attachment. Several oil companies invested in ECG equipment which allowed direct recording of the patient's ECG in electronic form for transmission by email. Uptake of the telemedicine service was very rapid. The majority of rig medics found the system very easy to use. During a 36-month study period from August 2004, 47 cases of chest pain were dealt with by telemedicine. Of these 47 cases, only six patients (13%) were airlifted to shore. The 41 remaining ECGs did not to have acute changes requiring immediate evacuation. The use of email for ECG transmission proved to be highly effective in managing chest pain offshore.
Implementation of a large-scale hospital information infrastructure for multi-unit health-care services
Authors: Yoo Sun K , Kim Dong Keun , Kim Jung C , Park Youn Jung , Chang Byung Chul
Published: April 2008

Summary

With the increase in demand for high quality medical services, the need for an innovative hospital information system has become essential. An improved system has been implemented in all hospital units of the Yonsei University Health System. Interoperability between multi-units required appropriate hardware infrastructure and software architecture. This large-scale hospital information system encompassed PACS (Picture Archiving and Communications Systems), EMR (Electronic Medical Records) and ERP (Enterprise Resource Planning). It involved two tertiary hospitals and 50 community hospitals. The monthly data production rate by the integrated hospital information system is about 1.8 TByte and the total quantity of data produced so far is about 60 TByte. Large scale information exchange and sharing will be particularly useful for telemedicine applications.
Estrogens Metabolism Associated with Polymorphisms: Influence of COMT G482a Genotype on Age at Onset of Canine Mammary Tumors
Authors: Pereira P. Dias , Lopes C. C. , Matos A. J. F. , Pinto D. , Gärtner F. , Lopes C. , Medeiros R.
Published: April 2008

Catechol-O-methyltransferase (COMT) is an important enzyme participating in inactivation of carcinogenic oestrogen metabolites. In humans there is a single nucleotide polymorphism in COMT gene (COMT va1158met) that has been associated with an increased risk for developing breast cancer. In dogs, there is a single nucleotide polymorphism in COMT gene (G482A), but its relation with mammary carcinogenesis has never been investigated. The aim of this study was to focus on the evaluation of such polymorphism as a risk factor for the development of mammary tumors in bitches and on the analysis of its relationship with some clinicopathologic features (dog's age and weight, number and histologic type of the lesions, lymph node metastasis) of canine mammary neoplasms. A case-control study was conducted analyzing 90 bitches with mammary tumors and 84 bitches without evidence of neoplastic disease. The COMT G482A polymorphism was analyzed by PCR-RFLP. We found a protective effect of the polymorphism in age of onset of mammary tumors, although we could not establish a significant association between COMT genotype and other clinicopathologic parameters nor with mammary tumor risk overall. Animals carrying the variant allele have a threefold likelihood of developing mammary tumors after 9 years of age in comparison with noncarriers. The Kaplan-Meier method revealed significant differences in the waiting time for onset of malignant disease for A allele carrier (12.46 years) and noncarrier (11.13 years) animals. This investigation constitutes the first case-control study designed to assess the relationship between polymorphic genes and mammary tumor risk in dogs. Our results point to the combined effect of COMT genotype with other genetic and/or environmental risk factors as important key factors for mammary tumor etiopathogenesis.
Vascular Endothelial Growth Factor mRNA Expression and Peritumoral Edema in Canine Primary Central Nervous System Tumors
Authors: Dickinson P. J. , Sturges B. K. , Higgins R. J. , Roberts B. N. , Leutenegger C. M. , Bollen A. W. , LeCouteur R. A.
Published: April 2008

Vascular endothelial growth factor (VEGF) is an important regulator of tumor angiogenesis and vascular permeability, and has been implicated both in progression of central nervous system (CNS) tumors and development of vasogenic peritumoral edema. A retrospective study was done to characterize the levels of expression of the 3 major canine VEGF isoforms (VEGF120, VEGF164, VEGF188) in a variety of spontaneous canine CNS tumors using quantitative TaqMan reverse transcription real-time polymerase chain reaction. Presence and degree of peritumoral edema also were determined in sampled tumors using magnetic resonance imaging (MRI). Increased expression of VEGF relative to normal cerebral cortex tissue was seen predominantly in high grade astrocytic (grade IV) and oligodendroglial (grade III) tumors, with lower expression in low grade astrocytomas (grade II) and meningiomas (grade I). All 3 major VEGF isoforms were present; VEGF164 was the predominant isoform, particularly in the tumors with the highest VEGF expression. Peritumoral edema was present in all tumor types; however, a significant association between the extent of peritumoral edema and the level of VEGF expression was not apparent.
Detection of Antigenic Heterogeneity in Feline Coronavirus Nucleocapsid in Feline Pyogranulomatous Meningoencephalitis
Authors: Poncelet L. , Coppens A. , Peeters D. , Bianchi E. , Grant C. K. , Kadhim H.
Published: April 2008

A new monoclonal antibody (mAb), CCV2-2, was compared with the widely used FIPV3-70 mAb, both directed against canine coronavirus (CCoV), as a diagnostic and research tool. Western blot showed that both anti-CCoV mAbs only reacted with a protein of 50 kD, a weight consistent with the feline coronavirus (FCoV) viral nucleocapsid. A competitive inhibition enzyme-linked immunosorbent assay showed that the 2 recognized epitopes are distinct. Preincubation of CCV2-2 mAb with FCoV antigen suppressed the immunostaining. Formalin-fixed, paraffin-embedded sections from brains of 15 cats with the dry form of feline infectious peritonitis (FIP) were examined by immunohistochemistry. Immunohistochemistry was performed with both anti-CCoV mAbs, either on consecutive or on the same sections. A myeloid-histiocytic marker, MAC 387, was also used to identify FIP virus-infected cells. In all regions where MAC 387-positive cells were present, positive staining with the CCV2-2 mAb was systematically detected, except at some levels in 1 cat. In contrast, none or only a few cells were positive for the FIPV3-70 mAb. Double immunostaining showed macrophages that were immunopositive for either CCV2-2 alone or alternatively for CCV2-2 and FIPV3-70 mAbs. This reveals the coexistence of 2 cohorts of phagocytes whose FIP viral contents differed by the presence or absence of the FIPV3-70-recognized epitope. These findings provide evidence for antigenic heterogeneity in coronavirus nucleocapsid protein in FIP lesions, a result that is in line with molecular observations. In addition, we provide for the first time morphologic depiction of viral variants distribution in these lesions.
Polysaccharide Storage Myopathy in Cob Normand Draft Horses
Authors: Larcher T. , Herszberg B. , Molon-Noblot S. , Guigand L. , Chaffaux S. , Guerin G. , Cherel Y.
Published: April 2008

Gluteus medius muscle was sampled from 53 Cob Normand horses for histologic evaluation. Twenty horses (38%) exhibited amylase-resistant material in myocytes consistent with polysaccharide storage myopathy. Diameter of affected type II fibers was increased (67.7 ± 21.4 μm) compared with normal ones (57.3 ± 19.7 μm). Two groups were distinguished by quantitative study. The first group (n = 14; 26%) was characterized by a low percentage of fibers (m = 0.98%) containing aggregates occurring singly or in perifascicular clusters without myopathic changes. The second group (n = 6; 11%) was characterized by a high percentage (m = 18.1%) of fibers containing aggregates scattered in biopsy with chronic myopathic changes. Rebiopsy of 4 horses showed an increase with time in the number of aggregate-containing fibers for horses of the first group only. In 1 necropsied horse, aggregates were observed in a wide range of muscles including smooth muscles. Ultrastructurally, granular material was found interspersed among arrays of filamentous material.
Histopathologic, Immunohistochemical, and Cytologic Analysis of Feline Myeloma-Related Disorders: Further Evidence for Primary Extramedullary Development in the Cat
Authors: Mellor P. J. , Haugland S. , Smith K. C. , Powell R. M. , Archer J. , Scase T. J. , Villiers E. J. , McNeil P. E. , Nixon C. , Knott C. , Fournier D. , Murphy S. , Polton G. A. , Belford C. , Philbey A. W. , Argyle D. J. , Herrtage M. E. , Day M. J.
Published: April 2008

Feline myeloma-related disorders (MRD) are rare neoplasms of plasma cells. The multistep transformation model of myeloma in humans is based on the premise that plasma cells undergo neoplastic transformation primarily within the intramedullary compartment and that over time they become poorly differentiated and metastasize to extramedullary locations. Historically, diagnostic criteria used for human multiple myeloma have been applied to the cat, with the assumption that feline MRD commonly arises in the intramedullary compartment. Our objectives were to describe the features of feline MRD confirmed by cytology, histopathology, histochemistry, and immunohistochemistry and to categorize these tumors. A priori hypotheses were 1) tumor category predicts survival and 2) cats with well-differentiated tumors commonly have extramedullary involvement in contrast to human myeloma patients. This multicenter, retrospective study identified 26 MRD cases. There was good agreement between histopathologic and cytologic tumor categorization. Histochemistry and immunohistochemistry were shown to be valuable adjunct tests in the diagnosis of MRD. Cats with well-differentiated tumors had increased median survival relative to those with poorly differentiated tumors (254 versus 14 days). We have reported that marked extramedullary involvement at initial clinical presentation is significantly more common in the cat than in human MRD patients. In this study, we demonstrate that cats with well-differentiated tumors more commonly have extramedullary involvement than human myeloma patients with well-differentiated tumors (90% versus 20%, P < 0.0002). These results contrast strongly with the human myeloma model of primary intramedullary neoplastic transformation and suggest that primary extramedullary neoplastic transformation may be more common in feline MRD.
The Clinical and Morphologic Features of Nonepidermolytic Ichthyosis in the Golden Retriever
Authors: Mauldin E. A. , Credille K. M. , Dunstan R. W. , Casal M. L.
Published: April 2008

A scaling disorder specific to Golden Retriever dogs has been recognized by both dermatologists and pathologists, but to date has not been well characterized. At the University of Pennsylvania's Laboratory of Toxicology and Pathology, 46 cases of ichthyosis were diagnosed histologically in Golden Retriever dogs from January 2004 to January 2007. A total of 22 dogs had skin lesions documented at younger than 1 year of age; 3 dogs between 1 and 2 years of age; 13 dogs developed lesions at older than 2 years; and the time of onset was unknown for 8 dogs. A total of 25 dogs were female, and 21 were male. All dogs had strikingly similar histopathologic changes that consisted of mild to moderate laminar orthokeratotic hyperkeratosis with an absence of epidermal hyperplasia and dermal inflammation. Ultrastructural analysis using a ruthenium tetroxide fixation method was performed on punch biopsy samples from 5 dogs and compared with 2 control dogs (1 clinically and histologically normal sibling of an affected dog and 1 Cairn Terrier). All affected dogs had retained and convoluted membranes with crystalline structures in the stratum corneum. Scattered keratinocytes in the granular cell layer had prominent, clear, membrane-bound, cytoplasmic vacuoles. Pedigree analysis of 14 dogs was compatible with autosomal recessive inheritance, but incomplete dominance could not be ruled out. This unique hyperkeratotic/scaling disorder in Golden Retrievers has distinctive clinical, histologic, and ultrastructural features, which are consistent with a primary cornification defect.
Nasal and Paranasal Adenocarcinomas with Neuroendocrine Differentiation in Dogs
Authors: Ninomiya F. , Suzuki S. , Tanaka H. , Hayashi S. , Ozaki K. , Narama I.
Published: April 2008

Tumors of the nasal cavity or paranasal sinuses of 18 dogs were examined histopathologically, immunohistochemically, and histochemically. The tumors were classified histologically as 13 adenocarcinomas, 3 transitional carcinomas, 1 squamous cell carcinoma, and 1 adenosquamous carcinoma. Tumor cells were strongly immunoreactive for broad-spectrum cytokeratins in all cases, for cytokeratin 8/18 in 16 cases, and for cytokeratin 19 in 17 cases. None of the 18 carcinomas had cytologic or histologic features indicative of neuroendocrine differentiation, yet tumor cells in 5 of the 13 adenocarcinomas were argyrophilic and immunohistochemically positive for synaptophysin and chromogranin A. Results of this study indicate that neuroendocrine markers may be detected immunohistochemically and histochemically in canine nasal or paranasal adenocarcinomas despite the lack of typical histologic features of neuroendocrine differentiation.
Multiple Cystic Intestinal Duplications in a Cat
Authors: Kershaw O. , Deppenmeier S. , Gruber A. D.
Published: April 2008

A 7-year-old, female European shorthair cat with a history of recurrent vomiting had a 2-cm cystic mass in the midjejunum. Cross-sectioning and histology revealed 3 separate cystic structures in the muscular layer, in addition to a regularly structured intestinal lumen. One cyst had a 3-layered wall consisting of a dysplastic mucosa, a regularly structured submucosa, and partly double-layered muscularis that sporadically contained neurons resembling a myenteric plexus. The remaining 2 cysts had similar structures except for granulation tissue lining the lumen. The lesion was diagnosed as multiple cystic duplications in the midjejunum, which is unknown to the veterinary literature to date.
Concurrent Peste des Petits Ruminants Virus and Pestivirus Infection in Stillborn Twin Lambs
Authors: Kul O. , Kabakci N. , Özkul A. , Kalender H. , Atmaca H. T.
Published: April 2008

Concurrent infection with peste des petits ruminants virus (PPRV) and pestivirus was diagnosed in stillborn twin lambs. With the flock history, the findings of epidermal syncytial cells and necrotizing bronchitis/bronchiolitis prompted testing for PPRV infection, and PPRV antigen was detected by immunohistochemistry (IHC) in the skin, lungs, kidneys, rumen, and thymus. Macroscopic anomalies that were typical of border disease included scoliosis, brachygnathism, prognathism, arthrogryposis, hydranencephaly, cerebellar hypoplasia, and hairy fleece; pestiviral antigen was detected by IHC in the brain, liver, lungs, and kidneys. Tissues from both lambs were positive by reverse transcriptase-polymerase chain reaction (RT-PCR) for PPRV and pestivirus. To the authors' knowledge, PPR has not been reported previously as a congenital infection or in combination with pestiviral infection.
Bone Dysplasia in the Radial and Ulnar Metaphysis of a Newfoundland Dog
Authors: Trangerud C. , Grøndalen J. , Ytrehus B.
Published: April 2008

A recently described metaphyseal irregularity of the radius and ulna was diagnosed radiographically in a significant proportion of Newfoundland dogs during the course of a large study. This case report describes the pathological picture of a Newfoundland dog with these radiographic changes. The lesions in the distal radius and ulna were characterized by focal, longitudinal striations of sclerosis of the bone marrow cavity, surrounding thin trabeculae of primary spongiosa of the distal metaphysis. It is suggested that these lesions represent a sclerosing dysplasia not previously described in dogs, but with some similarities to the human disorder, osteopathia striata.
Sphingomyelinase Deficiency (Niemann-Pick disease) in a Hereford Calf
Authors: Saunders G. K. , Wenger D. A.
Published: April 2008

A 5-month-old Hereford calf with neurologic disease was euthanatized, and a necropsy was done. No gross lesions were seen in the brain. Microscopically, neurons throughout the brain and spinal cord had distended, foamy vacuolated cytoplasm. Ultrastructure showed clear vacuoles filling the neuronal cytoplasm. A lysosomal storage disease was suspected. Sphingomyelinase deficiency was confirmed by biochemical analysis of liver and brain.
Mandibular Ossifying Fibroma in a Dog
Authors: Miller M. A. , Towle H. A. M. , Heng H. G. , Greenberg C. B. , Pool R. R.
Published: April 2008

An aged mongrel dog was admitted for hemimandibulectomy as treatment for a mandibular mass that had been diagnosed as osteosarcoma. The fibro-osseous mass that surrounded the first molar tooth and replaced alveolar and cortical bone was reclassified as ossifying fibroma on the basis of anatomic location and histologic features. The tumor was composed of isomorphic fusiform cells with few mitotic figures. Tumoral stroma contained trabeculae of woven bone that were bordered by a single layer of osteoblasts. Excision was deemed complete with no evidence of extension or metastasis by computed tomography of the skull or thoracic and abdominal radiography. The dog was reportedly healthy 6 months after initial presentation. Though far less common than osteosarcoma as a primary canine bone tumor, ossifying fibroma should be included in the differential diagnosis for fibro-osseous proliferations, especially those of the jaw. Although benign, en bloc excision may be necessary for surgical cure.
Xanthogranulomatous Inflammation of the Small Bowel in a Dog
Authors: Romanucci M. , Malatesta D. , Guardiani P. , Frescura P. , Della Salda L.
Published: April 2008

A case of xanthogranulomatous inflammation of the small bowel in a 12-year-old male American Staffordshire Terrier is described. Disseminated yellow-white nodules 2 to 3 mm in diameter bulging on the serosal surface of the small bowel, as well as on mesenteric tissue, were detected. Histopathologic examination revealed a nodular collection of foamy cells, mainly involving serosal and muscular layers, associated with necrotic areas, hemorrhages, neovascularization, variable numbers of reactive spindle cells, neutrophils, lymphocytes, plasma cells, and rare multinucleated giant cells. Transmural lymphangectasia and mucosal lymphoplasmacytic inflammation were also observed. Both Oil Red O stain and ultrastructural study revealed lipid droplets in the cytoplasm of foamy cells. Lysozyme immunoreactivity was detected in single as well as in clustered foamy cells, while smooth muscle actin was positive in spindle cells and scattered foamy elements. Lymphangectasia associated with lymphoplasmacytic enteritis suggests a component of lymphatic fluid stasis in the pathogenesis of such lesions.
Herpetiform Genital Lesions in a Heifer with Mucosal Disease
Authors: Fabis J. J. , Szkudlarek L. , Risatti G. R. , Sura R. , Garmendia A. E. , Van Kruiningen H. J.
Published: April 2008

A 14-month-old heifer with a 17-day history of unresponsive bloody diarrhea was necropsied. There were focal, pink-red erosions of the nares and hard palate; ulcers and fissures of the tongue; and multiple ulcerative lesions of the alimentary canal. Interdigital skin of both rear limbs was ulcerated and bleeding; and the margins of the vulva contained punctiform red ulcers. The gross lesions were consistent with mucosal disease. Histopathology and laboratory testing ruled out rinderpest, foot-and-mouth disease, and vesicular stomatitis, and identified bovine virus diarrhea virus to be the cause of this disease. Lesions of the vulva similar to those seen in some stages of infectious pustular vulvovaginitis were negative for bovine herpesvirus-1 and tested positive for bovine viral diarrhea virus antigen by immunohistochemistry.
The Immunohistochemical Evaluation of Estrogen Receptor-α and Progesterone Receptors of Normal, Hyperplastic, and Neoplastic Endometrium in 88 Pet Rabbits
Authors: Asakawa M. G. , Goldschmidt M. H. , Une Y. , Nomura Y.
Published: April 2008

The expression of estrogen receptor-α (ER) and progesterone receptor (PR) in normal, hyperplastic, and neoplastic endometrium in rabbits was evaluated by immunohistochemistry. The tissues evaluated were 27 normal uteri, 19 cases with endometrial hyperplasia, and 42 adenocarcinomas. Sixteen of 27 cases of normal uteri (59.3%) and 13 out of 19 hyperplasias (68.4%) stained positive with both ER-α and PR. Adenocarcinomas were further subdivided into 26 papillary and 16 tubular/solid adenocarcinomas. Papillary adenocarcinoma infiltrated the myometrium late in the disease and caused attenuation of the myometrium. In contrast, tubular/solid adenocarcinoma invaded into the deep myometrium early in the disease without thinning of the myometrium. Twenty-one cases out of 26 (80.8%) cases of papillary adenocarcinoma were both ER-α and PR negative, whereas 15 out of 16 (93.8%) of the tubular/solid adenocarcinomas were positive for ER-α, PR, or both. The total immunoreactive scores of ER-α, PR, and mode of myometrial invasion were significantly different between histopathologic types. This suggests that there may be 2 different developmental pathways for uterine adenocarcinomas in the rabbit.
Multisystemic Abscesses in African Green Monkeys (Chlorocebus aethiops) with Invasive Klebsiella pneumoniae—Identification of the Hypermucoviscosity Phenotype
Authors: Twenhafel N. A. , Whitehouse C. A. , Stevens E. L. , Hottel H. E. , Foster C. D. , Gamble S. , Abbott S. , Janda J. M. , Kreiselmeier N. , Steele K. E.
Published: April 2008

Invasive Klebsiella pneumoniae is an emerging disease of humans characterized by abscesses in the liver or other sites involving bacteria with the unique hypermucoviscosity phenotype. Over several months, 7 African green monkeys in our research colony developed abscess formation in multiple locations and succumbed to disease. K. pneumoniae was identified by bacterial culture in 6 monkeys and immunohistochemistry in 1 additional monkey. All monkeys had been housed in, or had contact with monkeys housed in, 1 animal room in our facility. All affected monkeys had 1 or more abscesses, most notably in the abdomen, but also affecting the lungs, cerebellum, and skin. Abdominal abscesses and associated adhesions entrapped loops of bowel, forming palpable masses. Abdominal masses were located at the root of the mesentery, the ileocecocolic junction, or the pelvic inlet. In 1 case, culture, serotyping, and polymerase chain reaction (PCR) analysis of the bacterial isolate identified K. pneumoniae expressing the hypermucoviscosity phenotype and capsular serotype K2 and determined that the K. pneumonia was genetically rmpA+/magA-.