bluuebunny/crossref_metadata_2025 huggingface dataset:
Closed Toggle Pinning for Canine Traumatic Coxofemoral Luxation
Authors: Serdy M. G. , Hornof W. , Koehler C. , Chiu D. , Vasseur P. B. , Schulz K. S.
Published: March 2018

A method of closed implantation of a toggle pin bone anchor and prosthetic ligament was developed for the treatment of traumatic canine coxofemoral luxation. Radiographic and anatomical evaluation of the canine femur and acetabulum were performed in order to develop an imaging and instrumentation technique that would allow closed placement of a toggle pin bone anchor under fluoroscopic guidance, while at the same time minimizing, or eliminating, damage to the articular cartilage. The surgical technique was then performed in 14 canine cadaver coxofemoral joints, followed by gross evaluation of implant placement, and potential cartilage or soft tissue damage. The cervical canal radiographic view of the proximal femur allowed placement of the drill hole through the fovea capitis of the femoral head without damaging the articular cartilage. The acetabular fossa was readily distinguishable from the acetabular articular cartilage on both of the lateral and ventrodorsal radiographic views of the pelvis. The toggle pin apparatus was inserted without damage to the articular cartilage in nine out of the fourteen hips and the bone tunnels were situated within the cancellous bone of the femoral neck in each of the nine specimens evaluated. Complications encountered during the procedure included bending and/or breakage of the guide wire in three hips and damage to the articular cartilage in two hips. The success of technique modifications designed to diminish the incidence of these complications awaits investigation in a clinical trial. Closed toggle pinning for canine traumatic coxofemoral luxation has the potential advantage of achieving rapid stabilization of the coxofemoral joint without damage to the articular cartilage and the need for an open approach to the joint. The clinical application of the technique is reported in one patient.

The equipment and methodology for closed implantation of a toggle pin bone anchor and prosthetic ligament was developed for the treatment of traumatic coxofemoral luxation. A cadaver study was performed to assess the viability of the technique. Clinical application in one case is described.
Fine Morphological Assessment of Stripped Screw Sites in Cortical Bone
Authors: Oliver J. L. , Hosgood G. , Moore R. M. , Fitch R. B.
Published: March 2018

Unintentional over-tightening of orthopaedic screws resulting in loss of screw purchase (“screw stripping”) is a potential complication during fracture fixation. This report describes the microstructural and radiographic effects on bone caused by stripping a 2.7 mm orthopaedic screw, and subsequent replacement in these stripped screw sites with either a 3.5 mm cortical or a 4.0 mm cancellous orthopaedic screws in both tapped and untapped holes. Over-tightening of a 2.7 mm screw resulted in shearing of the bone directly engaged by the screw threads. Additional fractures occurred in surrounding bone, primarily superficial subperiosteal saucer fractures in the cis cortex and to a lesser degree, in the subendosteum of the trans cortex. Bone damage was consistently more severe in the cis cortex. Salvaging stripped screw sites by insertion of a 3.5 mm or 4.0 mm screw resulted in additional fracturing and displacement, which was more severe in the untapped sites. Decreased holding power of screws placed in stripped screw sites could be attributed to collateral structural bone damage occurring during screw stripping and replacement screw application.

Over-tightening of orthopaedic screws until mechanical failure (“screw stripping”) results in damage to cortical bone which extends beyond the outer thread diameter of the screw. Damage, most often subperiosteal saucer fractures, was greater in the cis cortex. The subperiosteal saucer fractures decreased the functional length of screw engagement of the larger replacement screws in the cortical bone, which may account for decreases in expected holding power.
Replantation of a Partially Amputated Paw following Traumatic Laceration
Authors: Degner D. A. , Walshaw R. , Robertson Heather
Published: March 2018

Survival of the distal limb is dependent on the integrity of its vascular supply. Microvascular anastomosis of the median and caudal interosseus arteries following traumatic laceration of the palmar carpal region is described. Nine months after the operation, the dog was noted to have full function of the limb.
The Effects of Polysulphated Glycosaminoglycan on the Healing of Collagenase Induced Tendinitis
Authors: Booth L. C. , Pool R. R. , Redding W. R.
Published: March 2018

Objective. To examine the effects of polysulphated glycosaminoglycan on tendon healing in a controlled collagenase injury model. Design. The study used a completely randomized design with four horses assigned to each of two groups, control and treated. The superficial digital flexor tendons from each horse were measured weekly by ultrasound techniques. The differences between groups were evaluated using t-statistics and trends summarized by simple linear regression. Animals. Eight horses (four Thoroughbreds and four Standardbreds) with normal superficial flexor tendons were divided into two groups of four. Group #1 control horses were not treated. Group #2 horses were treated with polysulphated glycosaminoglycans. Procedure. All of the horses had tendinitis induced in the superficial flexor tendon of both forelimbs by the injection of 4000 IU of collagenase. The treated group received 500 mg of polysulphated glycosaminoglycan (PSGAG) IM every five days for seven treatments beginning 24 h after injection of collagenase. The control group received saline at the same time periods. Ultrasound examination of each limb was performed on days 1, 3, 5, and 7 post-injection and weekly thereafter for eight weeks. An image analysis system was used to measure the proportion of tendon area damaged in mm2 on the recorded images, and these values were plotted over time. The horses were euthanatized at eight weeks and histological evaluation was performed on longitudinal sections of excised tendons. Results. The size of the tendon core defects created by the collagenase enzyme, represented as the proportion of area damaged, decreased significantly faster in the treatment group (ρ <0.01). Histologic evaluation of the core defects confirmed what was seen sonographically. Conclusion. Polysulphated glycosaminoglycans had a positive effect on tendon healing in a collagenase induced tendinitis model. Clinical relevance. Polysulphated glycosaminoglycans may be beneficial in managing clinical cases of tendinitis.

Eight horses had experimental core defects induced in the superficial digital flexor tendon of both forelimbs. One group of four horses received PSGAG IM every 5 days for seven treatments. The control group received saline. The core defects in the PSGAG treatment group developed echogenic ultrasound patterns earlier, and the mean ratio of area of the tendon decreased significantly faster in the treatment group.
An Introduction to Distraction Osteogenesis and the Principles of the Ilizarov Method
Authors: Lewis D. D. , Welch R. D. , Samchukov M. , Marcellin-Little D. J. , Stallings J. T.
Published: March 2018

Although employed by some European veterinary surgeons for over 10 years to manage a variety of musculoskeletal conditions in dogs and cats, the methods of Ilizarov and circular external fixators are only recently being utilized by North American veterinary surgeons. There is little information on this subject in the veterinary literature. This article is designed to provide an introductory overview of the Ilizarov method with emphasis on the principles of distraction osteogenesis and the circular external skeletal fixator.

The history of the development of distraction osteogenesis and the principles governing the clinical application of the Ilizarov method are reviewed.
The influence of screw torque in the application of bone plates
Authors: Hearn T.C. , Woodside T.D. , Field J.R.
Published: March 2018

The applied level of screw torque has a significant impact on both the mechanical and vascular environment in bone following the application of a bone plate. The amount of torque applied dictates the resultant level of axial tension generated in the screw and the compressive forces between the plate and underlying bone. The interface contact area between the plate and underlying bone is also affected. As a consequence, screw torque can be implicated in the pathogenesis of implant induced osteopenia and other pathological occurrences that follow bone plate fixation.

The work performed was designed to evaluate the effect of the applied level of screw torque. The construction stiffness (rigidity) and bone surface strain was quantitated in response to variable levels of screw torque. This was performed utilizing intact and osteotomized cadaveric bone.

The current level of screw torque applied in the clinical situation, for 4.5 mm cortical screws, is approximately 5 Newton metres (Nm). It appears from the work presented herein, that lowering the level of applied screw torque does not adversely affect the rigidity of the final construction. This fact may serve to ameliorate the pathological consequences of applying screws and plates using current clinical criteria.

The amount of torque applied to screws in the application of bone plates has a profound effect on a number of elements, namely the interface contact area and force. The work presented examines the effect of screw torque on the rigidity and bone strain distribution of fractured bone following bone plate reconstruction. It appears that the use of lower levels of screw torque, than currently used in clinical practice, does not adversely effect the rigidity of the final construction. These findings support the notion that the level of screw torque applied may have a role in ameliorating the pathogenic response that occur following bone plate application, namely osteopaenia.
Short- and long-term results after surgical treatment of an ununited anconeal process in the dog
Authors: Felir M. , Molte I. , Meyer-Lindenberg A.
Published: March 2018

In a prospective trial over seven years (1993-1999), 44 joints from 41 dogs with an ununited anconeal process are reported. The average age of the animals was 23 weeks. With regard to breed distribution, the German Shepherd was most frequently represented with 29 animals.

In 35 joints, the anconeal process was stabilised with lag screw and pin, as there was no fibrous connection between the anconeal process and the ulna. Additionally, in all cases an ulna ostectomy was performed. In nine joints, the connection of the anconeal process to the olecranon was firm and only a proximal ulna ostectomy was performed. The patients were rechecked clinically and radiologically, at an average of 13 weeks post operation. With one exception, in all of the cases the apophysis was closed. The implants were removed in 25 patients. The surgical results were examined once more after an average of 20 months in 43 joints (40 dogs). 83.7% of the cases (n = 36) did not show any lameness after the combined therapy with fixation of the isolated anconeal process and osteotomy of the ulna (n = 28) or ulna ostectomy only (n = 8) and were assessed as ‘good’. Six dogs (five with fixation, one with ostectomy) showed some degree of lameness after heavy strain and were only evaluated as ‘satisfactory’. One dog still had a striking low to medium grade lameness, so that the result was regarded as ‘unsatisfactory’. With regard to the development of arthrosis, only nine of the 30 joints (30%) examined radiographically showed a mild increase of the arthroses during later examinations.

In many cases excision of the ununited anconeal process leads to unsatisfactory long-term results. Frequently surgical treatment does not lead to fusion. This paper describes a concept for treatment of an ununited anconeal process and the short- and long-term results. Proximal ostectomy of the ulna was performed, as a single measure, when the anconeal process was tightly in place. In joints with a loose anconeal process, the piece of bone was stabilised with implants, in addition to an ostectomy of the ulna. After an average of three months, the anconeal process had fused with the ulna, in all hut one case. In long-term follow-ups, after an average of 20 months, most of the dogs did not show any lameness, even after exercise. In only a few joints was a minor increase of arthrosis noted. The technique described is considered to be useful to treat the ununited anconeal process in young dogs.
Biomechanical evaluation of triple pelvic osteotomy with and without additional ventral plate stabilization
Authors: Hosgood G. , Staatz A. , Fitch R. B.
Published: March 2018

The triple pelvic osteotomy (TPO) is commonly performed for immature dogs with hip dysplasia despite screw loosening being a prevalent complication. A technique to diminish the incidence of screw loosening by reducing motion at the ilial osteotomy and reducing implant migration, was evaluated. Standard triple pelvic osteotomies, and triple pelvic osteotomies with additional ventral plate stabilization, were performed and biomechanically evaluated in canine cadaver pelves. Additional ventral plate fixation was found to significantly improve axial bending stiffness of TPOs. In vitro cyclical loading, performed in a manner to approximate post-operative weight-bearing, determined that additional ventral plate fixation significantly decreased the incidence of screw loosening and motion at the osteotomy site.
Radiographic evaluation and comparison of triple pelvic osteotomy with and without additional ventral plate stabilization in forty dogs - part 1
Authors: Kerwin S. , Hosgood G. , Rooney M. , Pluhar E. , Pelsue D. , Fitch R. B.
Published: March 2018

Triple pelvic osteotomies (IPO) were evaluated in 40 clinical cases. In 39 cases, these were young dogs with hip dysplasia; in one case, the TPO was used as a correction for a hip luxation. Unilateral TPOs were performed in twenty patients, twelve with traditional TPO (without additional ventral plate) and eight with additional ventral plate fixation. Bilateral TPOs were performed in twenty patients, thirteen with traditional TPO and seven with additional ventral plate. In traditional TPOs, evidence of implant failure occurred in 5 of 12 unilateral and 11 of 13 bilateral procedures. In TPOs with additional ventral plate fixation, minor screw loosening was detected in one of eight unilateral and zero of seven bilateral procedures. Statistically TPOs without additional ventral plate fixation had 9.2 times greater odds of screw loosening with significantly greater acetabular segment displacement (p < 0.01). Two traditional TPOs performed required additional surgery due to screw loosening. Other attempted additional stabilization techniques used with the TPO procedure included ilial body wiring, ischial body wiring, sacral screw purchase, and medial screw nuts, however these methods did not prevent loosening and migration. TPO with additional ventral plate fixation was highly effective at combating implant failure.
In vitro evaluation of fluorocarbon leader line for use as a fabella-tibial suture
Authors: Hosgood G. , Kerwin S. C. , Hedlund C. S. , Metcalf J. B. , Banwell M. N.
Published: March 2018

Cranial cruciate ligament rupture is a common injury in dogs, for which a variety of surgical techniques have been described. A commonly performed surgical technique is extracapsular stabilization with a lateral fabella-tibial suture (LFS) using large diameter nylon leader line (NLL). Inherent properties of NLL such as memory, low coefficient of friction, and large diameter may compromise knot security. Fluorocarbon (polyvinylidene fluoride; PVDF) has been investigated as a biomaterial for a variety of implants and is available as a high tensile strength fluorocarbon leader line (FCL). For a given tensile strength FCL is one-half the diameter of NLL. This study evaluated the force at failure, elongation, and stiffness of FCL compared to NLL for use as a LFS. The effects of steam and ethylene oxide sterilization on FCL were also evaluated. The results of this study demonstrate similar force at failure and stiffness for FCL when compared to NLL. In addition, the use of FCL may eliminate the elongation under low load observed with NLL. The mechanical properties of FCL loops were not affected by ethylene oxide sterilization. In contrast, steam sterilization caused significant detrimental effects on the mechanical properties of FCL and is not recommended. The reduced diameter and pliable feel of FCL allow for superior handling, formation of a less bulky and potentially more secure knot, and less foreign material in the region of implantation. FCL appears to be a suitable alternative material to NLL for a lateral fabella-tibial suture.
Comparison of the osteogenic effects between two surface interferential stimulation devices to enhance surgically based spinal fusion
Authors: Martinez S. A. , Smith L. V. , Carroll W. J. , Zimmermann J. A. , Shih M. S. , Feldman R. , Lincoln J. D. , Briggs K. K.
Published: March 2018

In human medicine, lumbar spinal fusion procedures for chronic degenerative conditions have significant failure rates leading to the formation of pseudoarthroses. Adjunct procedures including the use of electrical stimulation devices have been developed in animal models, and utilized in human clinical cases, in an attempt to reduce the incidence of nonunion. A randomized, controlled study was performed to compare the effects of two surface interferential stimulation devices (SIS) on a rabbit lumbar spinal fusion model. Twenty-five rabbits underwent bilateral intertransverse process arthrodesis at the L2-L3 disc space. The rabbits were divided into five groups: one control group receiving sham stimulation, and four treatment groups receiving interferential stimulation from one of two devices (RS4i at 13.3 mA, RS4i at 15.8 mA, RS4v at 11.6 mA, and RS4v at 14.8 mA). Dual energy X-ray absorptiometry analyses (DXA) were performed and at 2 week intervals to evaluate fusion site bone mineral density. All rabbits were euthanitized at eight weeks and fusion sites were evaluated for biomechanical strength and histomorphometric properties. There was not any difference in bone mineral density between the groups during the eight week test period. The uniaxial tension tests evaluating maximum load to failure, stiffness, and energy absorbed also resulted in no statistical differences between the groups. The RS4i device at 15.8 mA yielded an increased amount of lamellar bone compared to the control group (p = 0.02). The RS4v device at 11.6 mA resulted in less total bone than the control group (p = 0.04).
Talocalcaneocentral luxation combined with lateral instability of the talocrural joint in a dog and a cat
Authors: Schawalder P. , Schmökel H. G. , Hurter K.
Published: March 2018

Tarsal injuries occur commonly in the cat and the dog, often due to motor vehicle accidents. In two cases a talocalcaneocentral luxation was associated with lateral talocrural instability. The surgical fixation of the talocalcaneocentral luxation, employing Kirschner pins in a cat and a DC plate in a dog, together with stabilisation of the lateral talocrural joint resulted in good long-term healing. The main aim of the surgical techniques used in these two cases was to stabilise the joints, without crossing and immobilising the talocalcaneal joint.
Congenital patellar aplasia in a family of cats
Authors: Ralphs S. C. , Milovancev M.
Published: March 2018

A diagnosis of congenital bilateral patellar aplasia was made in two male littermate Siamese cats that presented for abnormal conformation and hind limb gait. Both cats had abnormalities of the femora, tibiae, fibulae, and tali. The owners reported that the cats were able to ambulate adequately in the house and jump onto low-lying objects. Other than signs related to this developmental anomaly, significant abnormal clinical signs were not noted in either cat. According to the owner, none of the other littermates were affected, but the seven year old sire displayed identical clinical signs. Unfortunately, the sire and littermates were not available for examination. Treatment was not pursued for either cat.
Surgical anatomy of the feline sacroiliac joint for lag screw fixation of sacroiliac fracture-luxation
Authors: Forterre F. , Brunnberg L. , Burger M.
Published: March 2018

Twenty-eight feline pelves (56 hemipelves) were examined in order to identify the location for optimal sacroiliac screw placement in sacroiliac fracture-luxation repair. A drill hole was started on the median plane of the hemipelvis in the centre of the body of the first sacral segment until it penetrated the lateral cortex of the ilial wing, thus providing optimal drill hole placement. The position of the drill hole on the articular surface of the sacral wing and on the lateral surface of the ilial wing was measured. The distance of the drill hole from the cranial margin of the sacral wing was 51% of sacral wing length, just cranial to the crescent shaped hyaline cartilage. The distance from the dorsal margin was 47% of sacral wing height. The drill bit direction has to be adjusted to the cranio-caudal inclination (range 10° to 29°) and dorso-ventral inclination (range 2° to 25°) of the sacral wing. A notch in the cranial edge of the sacral wing was present, with variable position, in 34% of the specimens and is consequently not a useful landmark for sacroiliac screw placement. The drill hole on the lateral surface of the ilium was located in craniocaudal direction at a distance of 69% of sacral tuber length, measured from the cranial dorsal iliac spine. The dorso-ventral position of the drill hole was at a distance of 52% of ilial wing height measured from the sacral tuber. The ventral gluteal line, present in 93% of the cases, is a useful landmark to locate optimal screw hole position on the ilial wing.
The clamp rod internal fixator application and results in 120 small animal fracture patients
Authors: Matis U. , Zahn K.
Published: March 2018

The clamp rod internal fixator (CRIF), also known as VetFix, consists of clamps that are slid onto a rod and fixed to the bone with screws. The objective of the present study was to evaluate the results of using the CRIF in 50 canine and 70 feline patients with closed (n = 93) and open (n = 10) transverse, oblique and comminuted fractures of the femur, tibia, humerus, acetabulum, radius, scapula and ulna. Fourteen further fractures were non-unions. In addition, the CRIF was used to repair three fracture-luxations of the spine. Fracture fixation was performed by application of one or two CRIF devices with 2.0, 2.7 or 3.5 mm cortical screws, using AO osteosynthesis instrumentation. Forty-five dogs and 55 cats were re-evaluated clinically and radiographically after an average of five months. Uneventful fracture healing occurred in 75 of these patients. In ten cases, follow-up was only available until six weeks post-surgery at which time fracture healing was incomplete. Of the total of 15 complications, five were resolved by exercise restriction alone, while the CRIF had to be replaced in six other patients. One cat with a spinal fracture-luxation was euthanized due to deterioration of neurological status. Three animals were unavailable for further follow-up. With the inclusion of both uneventful and complicated fracture healing, 86/90 patients ultimately achieved complete fracture healing. Our results suggest that the CRIF system can be used successfully to treat a great variety of fractures in dogs and cats.
Treatment of traumatic coxo-femoral luxation by cemented total hip arthroplasty
Authors: Pozzi A. , Kowaleski M.P. , Dyce J. , Johnson K.A.
Published: March 2018

Surgical procedures such as total hip arthroplasty (THA) or femoral head and neck excision may be indicated as a treatment for traumatic coxo-femoral luxation that is complicated by pre-existing joint disease, concurrent fractures or recurrent luxation. The purpose of our study was to evaluate outcome after treatment of traumatic coxo-femoral luxation by THA. Medical records of dogs undergoing cemented THA from 1996 to 2002 were reviewed. Inclusion criteria were coxofemoral luxation resulting from severe external trauma and radiographic follow-up of at least 3 months. Ten dogs (12 THA) met the criteria for inclusion. Complications included THA luxation (n = 1) and a non-displaced peri-prosthetic femoral fracture (n = 1) that healed without further surgery. Median cumulative function scores from client questionnaires after THA were not significantly different in dogs with previously normal (8, range: 7-10), (n = 5) and dysplastic (9, range: 7–16), (n = 5) hips (P = 0.410). Six dogs were available for re-examination and force plate analysis at greater than 6 months post-THA, and none of these dogs had any visible lameness. Peak vertical force (% BWt) showed a trend towards being less in THA (60.8±5.1) than non-operated (68.1±6.1) hindlimbs (P = 0.057), whereas vertical impulse (% BWt x sec) was similar in THA (9.1±1.6) and non-operated (9.8±1.2) hindlimbs (P = 0.286). Our findings indicate that THA can be a successful treatment for traumatic coxo-femoral luxation, irrespective of the dysplastic status of the joint prior to injury.
A case of invertebral disc degeneration and prolapse with Schmorl's node formation
in a sheep
Authors: Brown P. J. , Alterio G. L. D. , Fews D.
Published: March 2018

A Schmorl's node is the herniation of nucleus pulposus through the cartilaginous end plate of the vertebral disc into the body of the adjacent vertebra. Their formation is relatively common in people, and they may be symptomatic or asymptomatic. In contrast, there are few reported cases of Schmorl's nodes in non-human animals. This report describes a case of thoracic intervertebral disc degeneration, with Schmorl's node formation in a sheep.
Deep digital flexor tendon shortening as a treatment for distal interphalangeal joint hyperextension in a 2-year-old mare
Authors: Kramer J. , Kelmer G.
Published: March 2018

Shortening of the deep digital flexor tendon was performed by tenotomy, overlapping and anastomosis. The procedure was performed on a two-year-old Quarter Horse Mare with distal interphalangeal joint hyperextension with subluxation and metatarsophalangeal joint hyperextension. These problems originated from damage to the digital flexor tendons, presumably due to previous distal limb trauma. The procedure markedly improved the mare's level of comfort, degree of ambulation and limb conformation. Two years following surgery the mare was comfortable at pasture.
Femoral Head and Neck Excision Complicated by Ischiatic Nerve Entrapment in Two Dogs
Authors: Jeffery N. D.
Published: March 2018

Two dogs, both Doberman n pinschers, developed ischiatic nerve palsy following femoral head and neck excisions. Each had undergone surgery entailing the incorporation of a muscle flap (in one case deep gluteal, in the other biceps femoris) to reduce bone-on-bone contact after ostectomy. At later exploratory surgery, the ischiatic nerve was found to be entrapped by muscle in the ischiatic fossa, caudal to the greater trochanter. Partial excision of the ischium relieved the compression, allowing rapid recovery of function. The complication of ischiatic nerve entrapment may warrant consideration when contemplating femoral head and neck excision in cases in which the greater trochanter and ischial tuberosity are abnormally close.

Ischiatic nerve palsy developed several weeks after femoral head and neck excision in two Dobermann pinschers. Both dogs had undergone surgery involving muscle sling placement. The ischiatic nerve was found to be entrapped in muscle in each case. Resection of portions of the ischium allowed rapid recovery of function.
Effects of Tapping on the Holding Strength of Cancellous Bone Screws
Authors: Surowiak J. F. , Schatzker J. , Hearn T. C.
Published: March 2018

The purpose of the study was to determine whether tapping affects the holding strength of cancellous bone screws in soft material. Paired extraction tests were conducted using 6.5 mm cancellous bone screws in porous polyurethane foam. One member of each pair had a pre-tapped pilot hole, the other was inserted in a self-tapping manner. The maximum value of tensile force during extraction with a servohydraulic materials testing machine was recorded as the screw holding strength.

Comparison of the holding strengths between the pre-tapped and self-tapping groups revealed a lower mean holding strength for the pre-tapped group (p <0.05). This result contrasts with previous studies which showed that pre-tapping increases the holding strength of bone screws in relatively stronger materials. The effect of tapping on the holding strength of bone screws is therefore dependant on the material properties of the host medium.

This study examined the effect of tapping the pilot hole on the extraction strength of 6.5 mm cancellous bone screws in soft, synthetic cancellous material. In contrast with previous studies in stronger materials, it was found that tapping significantly reduces the holding strength of bone screws. The effects of tapping depend on the material properties of the host medium.
Clinical Review of the Mechanism and Applications of Hyperbaric Oxygen Therapy in Small Animal Surgery
Authors: Kerwin Sharon , Lewis D. D. , Strain G. S. , Hedlund Cheryl , Elkins A. D. , Hosgood Giselle
Published: March 2018

Hyperbaric oxygen therapy has shown benefits both experimentally and clinically in human disease associated with vascular compromise and reduced host defenses. Potential benefits include the stimulation of leucocyte and macrophage function, increased oxygen availability for cellular function, stimulation of wound healing, and direct antibacterial effects. Similar applications may exist in veterinary medicine. This study documents 14 consecutive animals treated with hyperbaric oxygen, as an adjunct to standard therapy, for degloving injuries and/or skin grafts (n = 6), severe trauma (n = 3), compromised wound healing (n = 3), osteomyelitis (n = 1), and for anaerobic infection (n = 1). Subjectively, recovery was improved in these animals. If available, hyperbaric oxygen therapy deserves consideration as an adjunct to standard therapy for certain disorders.

The potential benefits of hyperbaric oxygen therapy are discussed in the light of a study of 14 cases.
Internal Fixation of Long Bone Fractures in Farm Animals
Authors: Steiner A. , Iselin U. , Lischer C. , Auer J. A.
Published: March 2018

This study demonstrates that long bone fracture treatment in food and fibre producing animals is in most cases successful. The greatest disadvantage of such treatment are the costs of the surgery and implants.
The Classification of Canine Achilles’ Tendon Lesions
Authors: Meutstege F. J.
Published: March 2018

A classification system for Achilles’ tendon lesions in the dog is proposed for use in small animal veterinary surgery. The system is based on anatomical and pathological features of the lesion, and facilitates documentation and communication.
Transverse Deformation of Long Bones in Vivo During Lag Screw Application
Authors: Bubeck J. O. , Bruemmer H. , Hutzschenreuter P.
Published: March 2018

Under in vivo conditions, the transverse deformation of 11 sheep metacarpi was measured, with a special measuring device after insertion of a cortical screw as a lag screw. The outer diameter of a metacarpus in caudocranial direction in the area of the diaphysis is normally 12.98 ±0.44 mm. With a torque moment of 2 Nm, the outer diameter changed by minus 50.53 ± 14.58 (imwhen the cortex screw was inserted. Ten minutes later, the value had become minus 42.43 ± 13.3 nm. These and previous experiments have shown that a lag screw should not be tightened fully upon insertion, but retightened 2-3 times to obtain maximum stabilization of the fracture surfaces.
Integrierte psychiatrische Versorgung aus Sicht der Gesetzlichen Krankenversicherung
Authors: Roick C.
Published: March 2018

Die Integrierte Versorgung (IV) bietet viele Möglichkeiten zur Verbesserung der Versorgung psychisch kranker Patienten. Dies gilt besonders für Patienten mit schweren Erkrankungen, bei denen durch eine bessere Verzahnung der stationären und ambulanten Versorgung Rückfälle und Klinikaufnahmen vermieden werden könnten. Dabei können in der IV auch Therapieelemente eingesetzt werden, die in der Routineversorgung nicht generell zur Verfügung stehen. Zudem können die Bereiche psychiatrischer Versorgung stärker zusammengefasst werden, sodass die administrativen Barrieren zur Auswahl eines optimalen Versorgungsangebots für die Patienten niedriger sind. Dadurch kann die Versorgung flexibler und bedarfsgerechter erfolgen. Darüber hinaus können für die IV leitlinienorientierte, evidenzbasierte Behandlungspfade entwickelt werden, für deren Umsetzung ausgewählte Leistungsanbieter unter Vertrag genommen werden. Je pauschalierter die Vergütung in IV-Projekten gestaltet wird, umso wichtiger ist eine kontinuierliche Qualitätssicherung. Um aus den mit unterschiedlichen IV-Konzepten gesammelten Erfahrungen Erkenntnisse für die Weiterentwicklung der psychiatrischen Versorgung zu gewinnen, sollten Krankenkassen IV-Projekte mit Methoden evidenzbasierter Medizin evaluieren und die Ergebnisse veröffentlichen.
Hamburger Modell
Authors: Lambert M. , Bock T.
Published: March 2018

Kaum ein Versorgungssystem leistet sich soviel Neben- und Gegeneinander wie das deutsche. Die Ressourcen sind zersplittert und ungerecht verteilt. Ein Primat an Psychotherapie ist zu fordern, doch in der gegenwärtigen Struktur bleiben die Patienten mit ernsten Diagnosen allzu oft außen vor. Die Trennung von ambulanter und stationärer Versorgung zu überwinden, und die finanziellen Belohnungsmechanismen zu verändern, wäre ein echter Fortschritt. Doch wieder tun sich Widersprüche auf zwischen erfolgreichen Modellen und einer entgegen gesetzten Gesundheitspolitik. Integrierte Versorgung zeigt neue Wege auf; doch um die wirklich bedürftigen Patienten zu erreichen, müssen die Ressourcen der Kliniken einfließen. Das Hamburger Modell setzt neue Maßstäbe für die Krankenhausversorgung. Doch dafür sind nicht nur andere Abrechnungsmechanismen und neue Behandlungswege nötig; es geht dabei auch um eine andere Haltung, eine Integration in den Köpfen, um anthropologisches Verständnis, Integration von Psychotherapie und Dialogbereitschaft. Die Integration von Peer-Beratung kann diesen Weg unterstützen.
Gemeindepsychiatrie gestaltet Zukunft
Authors: Faulbaum-Decke W.
Published: March 2018

Die Integrierte Gesundheitsversorgung (IGV) ist ein zeitgemäßes Konzept, das die Behandlungssituation von Menschen mit psychischen und seelischen Erkrankungen weiter verbessert. Aufsuchende Hilfen in einer ambulanten Struktur stärken sie darin, selbstbestimmt zu leben. Evidenzbasiert gilt eine ambulante Netzwerkstruktur als die Behandlungsform mit den besten Erfolgsaussichten. Sie ist den höchsten nationalen und internationalen Qualitätsstandards und Leitlinien verpflichtet. Mit der Umsetzung der IGV sind mindestens drei große Chancen verbunden: 1. Das Konzept ordnet nicht allein die gemeindepsychiatrische Arbeit neu, die Versorgungslandschaft insgesamt ist von allen Akteuren gemeinsam neu zu gestalten. 2. Leistungsangebote der gesetzlichen Krankenversicherung sind schneller und mit weniger administrativem Aufwand umzusetzen. 3. Die entsprechenden Hilfen orientieren sich an der Lebenswelt der Patienten, damit erhöht sich ihre Chance auf soziale und berufliche Teilhabe. Die weiteren Schritte erfordern vor allem eines: dass die Beteiligten sektorenübergreifend mehr ins Gespräch kommen und miteinander im Gespräch bleiben.
Integrierte Versorgung aus Sicht der Versorgungsforschung und Gesundheitsökonomie
Authors: Jacke C. O. , Salize H. J.
Published: March 2018

Modelle der Integrierten Versorgung (IV) sind angetreten, um bestehende Mängel im deutschen Versorgungssystem zu überwinden. Der vorliegende Beitrag skizziert die legislativen Hintergründe dieser Entwicklung, fasst Gütekriterien zur Bewertung komplexer Interventionen zusammen und wendet diese auf Studien an, die eine empirische Evidenz zu psychiatrisch-psychotherapeutischen IVModellen in Deutschland anbieten. Es gingen zwei populationsbasierte Studien in die Bewertung ein, die aus Sicht der Versorgungsforschung und Gesundheitsökonomie analysiert wurde. Die Studien besitzen eine hohe Güte und beachten die aufgestellten Kriterien im hohen Umfang. Eine dritte Studie befasst sich mit einem Teilaspekt. Aus Sicht der Versorgungsforschung und Gesundheitsökonomie besteht derzeit ein Theorie-, Methoden-, Ergebnis- und Verwertungsdefizit, um höhere Effektivität und Effizienz mit IV-Modellen zu erreichen. Ausgewählte Aspekte zur Weiterentwicklung von Projekten und ihren Bewertungen warden diskutiert.
Pelvic fractures in the dog and cat: a classification system and review of 556 cases
Authors: Montavon P. M. , Messmer M.
Published: March 2018

A system for the classification of pelvic fractures in small animals is described. The system is based on a review of 556 cases and adapted from the AO/ASIF classification system for fractures of long bones in humans and small animals. A coding method was created to encompass the multiple sites in pelvic fractures, and associate fracture location and morphology with complexity of therapy and prognosis. The classification is based on criteria derived from standard radiographs and well-defined in a glossary of terms. Illustrations of fracture configurations given by the codes facilitate the designation of codes to cases. This article introduces the classification system and reports the findings when applied to 556 cases of pelvic fractures.
Quality Assessments of HMO Diagnosis Databases Used to Monitor Childhood Vaccine Safety
Authors: Drew L. , DeStefano F. , Maher J. , Bohlke K. , Immanuel V. , Black S. , Lewis E. , Ray P. , Vadheim C. , Lugg M. , Chen R. , Mullooly J.
Published: March 2018

Objective:
To assess the quality of automated diagnoses extracted from medical care databases by the Vaccine Safety Datalink (VSD) study.

Methods:
Two methods are used to assess quality of VSD diagnosis data. The first method compares common automated and abstracted diagnostic categories (“outcomes”) in 1-2% simple random samples of study populations. The second method estimates positive predictive values of automated diagnosis codes used to identify potential cases of rare conditions (e.g., acute ataxia) for inclusion in nested case-control medical record abstraction studies.

Results:
There was good agreement (64-68%) between automated and abstracted outcomes in the 1-2% simple random samples at 3 of the 4 VSD sites and poor agreement (44%) at 1 site. Overall at 3 sites, 56% of children with automated cerebella ataxia codes (ICD-9 = 334) and 22% with “lack of coordination” codes (ICD-9 = 781.3) met objective clinical criteria for acute ataxia.

Conclusions:
The misclassification error rates for automated screening outcomes substantially reduce the power of screening analyses and limit usefulness of screening analyses to moderate to strong vaccine-outcome associations. Medical record verification of outcomes is needed for definitive assessments.
A Ruler for Interpreting Diagnostic Test Results
Authors: Lehmacher W. , Hellmich M.
Published: March 2018

Objectives:
Bayes’ rule formalizes how the pre-test probability of having a condition of interest is changed by a diagnostic test result to yield the post-test probability of having the condition. To simplify this calculation a geometric solution in form of a ruler is presented.

Methods:
Using odds and the likelihood ratio of a test result in favor of having the condition of interest, Bayes’ rule can succinctly be expressed as ”the post-test odds equals the pre-test odds times the likelihood ratio”. Taking logarithms of both sides yields an additive equation.

Results:
The additive log odds equation can easily be solved geometrically. We propose a ruler made of two scales to be adjusted laterally. A different, widely used solution in form of a nomogram was published by Fagan [2].

Conclusions:
Whilst use of the nomogram seems more obvious, the ruler may be easier to operate in clinical practice since no straight edge is needed for precise reading. Moreover, the ruler yields more intuitive results because it shows the change in probability due to a given test result on the same scale.
Normalization for Affymetrix GeneChips
Authors: Neuhäuser M. , Boes T.
Published: March 2018

Objectives:
The high density oligonucleotide micro-arrays from Affymetrix (Affymetrix GeneChips) are very popular in biomedical research. They enable to study the expression of thousands of genes simultaneously. In experiments with multiple arrays, normalization techniques are used to reduce the so-called obscuring variation, i.e. the technical variation that is of non-biological origin. Several different normalization methods have been proposed during the last years.

Methods:
We review published results about the comparison of normalization methods proposed for Affymetrix GeneChips.

Results:
The quantile normalization seems to perform favorably regarding precision (low variance), accuracy (low bias), and practicability (low computing time). However, according to very recent results [1], this normalization method can have an impact on the biological variability and, therefore, appears to be less than optimal from this point of view.

Conclusion:
Although the quantile normalization may be recommendable, more investigations based on more data sets are needed so that the different normalization methods can be evaluated on widely differing data.
A Novel Artificial Intelligence Method for Weekly Dietary Menu Planning
Authors: Vassányi I. , Kozmann G. , Gaál B.
Published: March 2018

Objectives:
Menu planning is an important part of per-sonalized lifestyle counseling. The paper describes the results of an automated menu generator (MenuGene) of the web-based lifestyle counseling system Cordelia that provides personalized advice to prevent cardiovascular diseases.

Methods:
The menu generator uses genetic algorithms to prepare weekly menus for web users. The objectives are derived from personal medical data collected via forms in Cordelia, combined with general nutritional guidelines. The weekly menu is modeled as a multilevel structure.

Results:
Results show that the genetic algorithm-based method succeeds in planning dietary menus that satisfy strict numerical constraints on every nutritional level (meal, daily basis, weekly basis). The rule-based assessment proved capable of manipulating the mean occurrence of the nutritional components thus providing a method for adjusting the variety and harmony of the menu plans.

Conclusions:
By splitting the problem into well determined sub-problems, weekly menu plans that satisfy nutritional constraints and have well assorted components can be generated with the same method that is for daily and meal plan generation.
A Four-dimensional Approach to Medical Image Retrieval
Authors: Amghar Y. , Flory A. , Chbeir R.
Published: March 2018

Image retrieval is faced with different problems. Few proposed solutions consider the heterogeneity of user competence (e.g. physicians, researchers, students, etc.) and the necessity of a high expressive power for medical image description. This paper presents a solution designed for medical imaging retrieval. It consists of providing a four-dimensional approach able to integrate different views of the medical image, to deal with complex medical queries. Via use of the Spatial Knowledge Model, we propose hybrid (textual and visual) and customizable interfaces, appropriate for non-computer scientist users. Our prototype, accessible through the Web, has been tested by a group of medical students and physicians and gives very satisfactory results.
Probabilistic Record Linkage: Relationships between File Sizes, Identifiers, and Match Weights
Authors: Olson L. M. , Dean J. M. , Cook L. J.
Published: March 2018

This study investigates relationships between file sizes, amounts of information contained in commonly used record linkage variables, and the amount of information needed for a successful probabilistic linkage project. We present an equation predicting the amount of information needed for a successful linkage project. Match weights for variables commonly used in record linkage are measured using artificially created databases. Linkage algorithms were successful when the sum of minimum weights for variables used in a linkage exceeded the predicted cutoff. Linkage results were acceptable when this sum was near the predicted cutoff. This technique enables researchers to determine if enough information exists to perform a successful probabilistic linkage.
Status and Perspective of Hospital Information Systems in Japan
Authors: Ogushi Y. , Okada Y. , Kimura M. , Kumamoto I , Sekita Y. , Haruki Y.
Published: March 2018

Questionnaire surveys were sent to hospital managers, designed to shape the policy for future hospital information systems in Japan. The answers show that many hospitals use dedicated management systems, especially for patient registration and accounting, and personnel, food control, pharmacy and financial departments. In many hospitals, order-entry systems for laboratory tests and prescriptions are well developed. Half of the hospitals have patient databases used for inquiries of basic patient information, history of outpatient care and hospital care. The most obvious benefit is the reduction of office work, due to effective hospital information system. Many hospital managers want to use the following sub systems in the future for automatic payment, waiting time display, patient records search, automatic prescription verification, drug side-effect monitoring, and graphical display of patient record data.
Design Elements for a Computerized Patient Record
Authors: Adelhard K. , Hölzel D. , Überla K.
Published: March 2018

Computerized medical record systems have to present user-and problem-oriented views of a patient record to health-care professionals. Presentation and manipulation of data must be easily adaptable to current and future demands of medical specialties and specific settings. During the definition, development and evaluation of a prototype of a computerized patient record system, design elements were elaborated to support physicians and other health-care professionals. Our approach shows a high degree of flexibility and adaptability to specific needs, problem orientation and connectivity to other systems, via a hospital information network. The explicit description of the contents of a patient record allows to augment the number of items that can be recorded without modifying the data structure. New views on patient data can be added to the system without interfering with the routine use of the system. Application in several medical specialties proved the feasibility of our prototype.
An Electronic Study Form to Support Collaborating Agents in the Management of Clinical Knowledge
Authors: Fierz W. , Grütter R.
Published: March 2018

When dealing with biological organisms, one has to take into account some peculiarities which significantly affect the representation of knowledge about them. These are complemented by the limitations in the representation of propositional knowledge, i. e. the majority of clinical knowledge, by artificial agents. Thus, the opportunities to automate the management of clinical knowledge are widely restricted to closed contexts and to procedural knowledge. Therefore, in dynamic and complex real-world settings such as health care provision to HIV-infected patients human and artificial agents must collaborate in order to optimize the time/quality antinomy of services provided. If applied to the implementation level, the overall requirement ensues that the language used to model clinical contexts should be both human- and machine-interpretable. The eXtensible Markup Language (XML), which is used to develop an electronic study form, is evaluated against this requirement, and its contribution to collaboration of human and artificial agents in the management of clinical knowledge is analyzed.