Assessment of low-cost teleradiology for grading elbow dysplasia.

Teleradiology involves the creation of a radiographic image that is then transmitted electronically. It has been shown that low-cost teleradiology has a high level of agreement when comparing the original radiograph to the digital image. However, there has been little investigation of the effect of digitization on the score allocated by a grading scheme. Radiographs of 60 canine elbows were selected, each in three projections (mediolateral flexed, mediolateral neutral, craniocaudal). Each radiograph was photographed at 3 megapixel (3 M) and 6 megapixel (6 M) resolution using a digital camera. The images were placed in groups (radiographs, 3 M and 6 M) and randomized. Each elbow was independently graded by a radiologist and an orthopedic surgeon using the BVA elbow scoring scheme, with the different image sets interpreted separately. Intra and interobserver agreement was compared using a kappa analysis. The radiologist had substantial intraobserver agreement for repeated grading of radiographs, and moderate agreement for the other intraobserver tests (3 M vs. radiographs, 6 M vs. radiographs, 3 vs. 6 M). The surgeon had moderate to substantial agreement for the intraobserver tests. There was reduced interobserver agreement for all image groups. These results suggest that low-cost teleradiology may only allow moderate accuracy when used for grading schemes, and this may affect its use for breed scoring schemes. However, there appears to be an inherent subjectivity present in the elbow-grading scheme, seen in both intra and interobserver analysis. Therefore, further study of teleradiology using a different scoring model (e.g., hip dysplasia) may be indicated.     

Genetic analyses of elbow and hip dysplasia in the German shepherd dog

Results from radiographic screening for canine hip dysplasia (CHD) and elbow dysplasia (CED) of 48 367 German shepherd dogs born in 2001–07 were used for the population genetic analyses. Available information included CHD scores for 47 730 dogs, CED scores for 28 011 dogs and detailed veterinary diagnoses of primary ED lesions for a subsample of 18 899 dogs. Quasi‐continuous traits were CHD, CED and cases of CED without radiographically visible primary lesion (CED‐ARTH). Binary coding was used for fragmented medial coronoid process of the ulna (FCP), borderline findings and mild to severe signs of dysplasia in hip and elbow joints. Genetic parameters were estimated in univariate threshold and multivariate linear and mixed linear‐threshold models using Gibbs sampling. Correlations between univariately predicted breeding values (BV) indicated genetic differences between borderline and affected disease status for both CHD (r_BV = 0.5) and CED (r_BV = 0.3). Multivariate genetic analyses with separate consideration of borderline findings revealed moderate heritabilities of 0.2–0.3 for the quasi‐continuous traits with positive additive genetic correlation of 0.3 between CHD and both CED and CED‐ARTH. For FCP, heritability of 0.6 and additive genetic correlations of +0.1 to CHD and ?0.1 to CED‐ARTH were estimated. Results supported the relevant genetic determination of CHD and CED, argued for both diseases against interpretation of borderline findings as healthy and implied genetic heterogeneity of CED. Accordingly, future breeding strategies to reduce the prevalences of CHD and CED in the German shepherd dog should be most efficient when based on BV from multivariate genetic evaluation for CHD, CED‐ARTH and FCP with use of the whole scale of categories for classification of CHD and CED.     

Symmetry of hip dysplasia traits in the German Shepherd Dog in Australia

Canine hip dysplasia (CHD) is a common and debilitating developmental condition of the canine coxofemoral (hip) joint, exhibiting a multifactorial pattern of inheritance. British Veterinary Association hip traits (BVAHTs) are nine radiographic features of hips used in several countries to ordinally score both the right and left hip of potential breeding candidates to assess their suitability for breeding. The objective of this study was to examine some aspects of the relationship between contralateral scores for each BVAHT in a cohort of 13 124 Australian‐registered German Shepherd Dogs. Goodman and Kruskal gamma coefficients of 0.48–0.95 and correlation coefficients of 0.50–0.74 demonstrate that the association between right and left hip scores varies between moderate and strong for BVAHTs. Principal component analysis of scores detected a sizeable left‐versus‐right effect, a finding supported by symmetry and quasi‐symmetry analyses which found that seven of the nine BVAHTs display significant marginal asymmetry. Dogs showing asymmetry for one BVAHT are significantly more likely to display asymmetry at other BVAHTs. When asymmetry is expressed as a binary trait (either symmetrical or asymmetrical), it displays low to moderate heritability. Estimates of genetic correlations between right and left scores are very high for all BVAHTs (>0.945), suggesting right and left scores for each BVAHT are largely determined by the same set of genes. The marginal asymmetries are therefore more likely to be of environmental and non‐additive genetic origin. In breeding programmes for CHD, we recommend that scores from both hips be used to estimate breeding values, with a term for side‐of‐hip included in the model to account for score variation owing to asymmetry.     

Prevalence and co-occurrence of hip dysplasia and elbow dysplasia in Dutch pure-bred dogs

Hip as well as elbow dysplasia (HD, ED) are developmental disorders leading to malformation of their respective joints. For a long time both disorders have been scored and targeted for improvement using selective breeding in several Dutch dog populations. In this paper all scores for both HD and ED, given to pure bred dogs in the Netherlands from 2002 to 2010, were analyzed. Heritabilities and correlations between HD and ED were calculated for the 4 most frequently scored breeds. Heritabilities ranged from 0.0 to 0.37 for HD related traits (FCI-score, osteoarthritis, congruity, shape and laxity (Norberg angle); FCI: Fédération Cynologique Internationale) and from 0.0 to 0.39 for ED related traits (IEWG score, osteoarthritis, sclerosis and indentation; IEWG: International Elbow Working Group). HD related traits showed high genetic and residual correlations among each other but were only to a minor extent correlated with ED related traits, which also showed high correlations among each other. Genetic correlations were higher than residual correlations. Phenotypic and genetic trends since 2001 for the four most scored breeds were slightly positive but decreasing over time, indicating that selection over the past decade has not been effective.     

Sensitivity and specificity of radiography for detection of elbow incongruity in clinical patients

Elbow incongruity is an important factor regarding the treatment and prognosis of elbow dysplasia. Our purpose was to determine the sensitivity and specificity for radiographic detection of elbow incongruity in clinical patients, to establish inter- and intraobserver variation for different parameters, and to evaluate the possibility of radiographic grading of incongruity. Standard radiographic projections were acquired from 29 incongruent and nine congruent elbows of dogs of various ages and breeds. Computed tomography (CT) was used to diagnose and grade the incongruity. All radiographs were evaluated by four observers for detection and grading of elbow incongruity. Sensitivity, specificity, inter- and intraobserver variability were calculated. The mean sensitivity for detection of incongruity was very good (88.8%) with a mean specificity of 91.7%. Correct grading of incongruity was difficult. The radioulnar step and the widening of the humeroulnar and humeroradial joint space were seen most frequently. Intraobserver and interobserver variability were fair to excellent (Kappa = 0.372-0.809), depending on the investigated parameters. Radiography is valuable to screen for elbow incongruity. In over 91% of the patients, a clear distinction could be made between a congruent and an incongruent joint grading was not possible.     

Impact of sedation method on the diagnosis of hip and elbow dysplasia in Swedish dogs

Our objective was to investigate the effect of sedation method on the screening result for hip and elbow dysplasia. The study was based on a questionnaire survey of routines for hip and elbow screening at Swedish veterinary clinics and results of hip and elbow status, for eight breeds (Bernese Mountain Dog, Boxer, German Shepherd Dog, Golden Retriever, Labrador Retriever, Newfoundland, Rottweiler, and Saint Bernard) recorded by the Swedish Kennel Club. In total 5877 and 5406 dogs examined for hip and elbow dysplasia, respectively, from January 2002 through March 2003 were included. We used logistic regression to examine whether the type of chemical restraint used for sedation affected the screening result for hip and elbow dysplasia. In addition to sedation method, the effects of veterinary clinic, sex, breed, and age at screening were studied.

The type of chemical restraint used for sedation affected the screening result for hip but not for elbow dysplasia. Acepromazine gave less than half the odds of hip dysplasia compared with medetomidine and butorphanol (the most common method), medetomidine alone or xylazine. Females had about 25% higher odds for developing hip dysplasia whereas males had almost 40% higher odds for developing elbow dysplasia. Saint Bernard, Newfoundland and German Shepherd Dog had the highest odds of developing hip dysplasia, whereas Rottweiler and Labrador Retriever had the lowest odds. Boxer had the lowest risk for elbow dysplasia, followed by Labrador Retriever. Saint Bernard and Rottweiler had the highest odds of elbow dysplasia. Increasing age increased the odds of both hip and elbow dysplasia, by about 2.5% per month.

Following the results in this study, recording of the type of chemical restraint used for sedation during hip screening has now become mandatory in Sweden. This makes it possible to account for the effect of sedation method in a model for prediction of breeding values for hip dysplasia.     

The intra‐ and intertester repeatability of radiographic elbow incongruity grading is high in chondrodystrophic dog breeds

Elbow incongruity is a form of elbow dysplasia that causes osteoarthritis, pain, and lameness, and it is common in chondrodystrophic dog breeds. The objective of this retrospective secondary analysis study was to evaluate the intra‐ and interobserver repeatability of a novel radiographic incongruity grading system for assessing elbow incongruity in three chondrodystrophic dog breeds—the dachshund, Skye Terrier, and Glen of Imaal Terrier. We conducted an observer agreement study that included 220 mediolateral antebrachial radiographs from 110 dogs with the elbow in 90° flexion. The radiographs were independently assessed by three observers at three time points, using a four‐stepped grading scale. The proportion of agreement and Kappa coefficient were calculated. Both the intra‐ and interobserver proportions of agreement were substantial when three grades were required to be identical (.705‐.777 and .609, respectively), and almost perfect for two identical grades (.991‐1.000 and .991, respectively). Some differences in repeatability between breeds were noted; specifically, the intraobserver repeatability was higher in the dachshund, and the interobserver repeatability was lower in the Glen of Imaal Terrier. Our study showed that the radiographic imaging protocol and incongruity grading system have high repeatability when assessing elbow incongruity in chondrodystrophic dog breeds.     

Cloning, expression and in vitro evaluation of recombinant canine Tum5, an angiostatic domain of mammalian type IV collagen

The process of new blood vessel formation within and around neoplastic tissue, termed angiogenesis, is a significant factor in the development, progression and metastasis of malignant tumours in all species. A major cause of death in cancer patients is the development of treatment‐resistant metastatic disease, which may be avoided by therapies that target the genetically stable population of vascular endothelial cells within tumours. Tumstatin is a small protein formed by the cleavage of the alpha‐3 subunit of the non‐collagenous domain of mammalian type IV collagen. Recombinant human Tumstatin has been shown to have potent angiostatic properties in vitro and in vivo. Tumstatin is a potent initiator of apoptosis and inhibits the proliferation and migration of vascular endothelial cells in cell culture. Recently, a fragment of Tumstatin, termed Tum5, has been shown to have biologic activity similar to the parent compound. The systemic administration of angiostatic proteins like Tum5 may result in the remission of established tumours, while preventing or delaying the onset of clinically detectable metastasis. Recombinant canine Tum5 (cTum5) was cloned and its protein expression induced in a prokaryotic vector. The resulting cTum5 protein caused dose‐dependent inhibition of vascular endothelial cells in vitro, which appears to be mediated through apoptosis.     

Radiographic assessment of humeroulnar congruity in a medium and a large breed of dog

Elbow joint incongruity is recognized as an important factor in the development, treatment, and prognosis of canine elbow dysplasia. Elbow incongruity has been measured based on radiographic joint space widths, however these values can be affected by the degree of elbow joint flexion. Recent studies have reported radiographic curvature radii as more precise measures of humeroulnar congruity in dogs. The aim of this prospective observational study was to describe radiographic curvature radii measured from flexed and extended elbow radiographs for a sample of dogs representing a medium breed (Portuguese Pointing Dog) and a large breed (Estrela Mountain Dog). The curvature radii from the ulnar trochlear notch and humeral trochlea were measured in 114 mediolateral elbow extended radiographic views (30 Portuguese Pointing Dog and 27 Estrela Mountain Dog), and 84 mediolateral flexed views (22 Portuguese Pointing Dog and 20 Estrela Mountain Dog). The sampled animals' ages ranged from 12 to 84 months (34.6 ± 17.8 months). Good agreement was observed between curvature radii measurements for flexed vs. extended views in both breed groups. Ulnar trochlear notch curvature radii measurements were greater than humeral trochlea curvature radii measurements in both breed groups. Both curvature radii were greater in the large‐breed dog group vs. the medium‐breed dog group. Both breed groups had ulnar and humeral curves with similar typology. However, the large breed group had greater intermediate differences between the humeroulnar surface curvature radii. Results from this study supported the use of curvature radii as measures of humeroulnar congruity in mediolateral flexed elbow radiographs of medium and large breed dogs.     

Resolution of persistent oral papillomatosis in a dog after treatment with a recombinant canine oral papillomavirus vaccine

This report describes a 16‐month‐old female, otherwise seemingly healthy, Siberian husky dog with severe oral papillomatosis that did not regress spontaneously and was refractory to surgical treatment over a 6‐month period. Regression of the papillomas was achieved by administering a series of experimental vaccinations starting at the time of the last surgery. The vaccine consisted of systemically administered canine oral papillomavirus major coat protein L1 that has been shown to self‐assemble into virus‐like particles. They cause a humoral response that has been shown to prevent the onset and development of papillomas. In this case, however, following unsuccessful surgical treatment, the vaccine acted therapeutically, causing the papillomas that had regrown to shrink. No side‐effects were noted.     

The use of delayed gadolinium enhanced magnetic resonance imaging of cartilage and T2 mapping to evaluate articular cartilage in the normal canine elbow

Commonly used diagnostic tools used to evaluate articular cartilage lack the sensitivity, specificity, and objectivity to measure early changes associated with osteoarthritis. Two techniques using magnetic resonance (MR) imaging have been developed to detect the biology of articular cartilage are delayed gadolinium-enhanced MR imaging of cartilage (dGEMRIC) and T2 mapping. Both techniques have been validated and are used to study the degenerative and adaptive nature of articular cartilage in people. The use of these techniques as a diagnostic tool in dogs has not been well described. We evaluated articular cartilage in the region of the medial coronoid process (MCP) of six healthy dogs free of detectable orthopedic disease using both MR imaging techniques. Histology and proteoglycan (PG) content of the MCP were used to confirm normal articular cartilage. All dogs had ground reaction forces consistent with normal function. Mean dGEMRIC index (T1 value) was 400 +/- 47 ms and mean T2 value was 56 +/- 8 ms. Intra- and interobserver variability was low. dGEMRIC and T2 values for normal cartilage in the elbow of the dog can be generated reproducibly using 3T MR imaging. Using these techniques as objective outcome measures for clinical studies in dogs with OA conditions should help delineate the efficacy of some disease interventions.     

Arthroscopically‐assisted removal of an osteochondral fragment from the equine elbow using a caudo‐medial approach

An 8‐year‐old Polo pony mare was admitted for investigation of lameness related to swelling of the elbow. An intra‐articular fragment from the proximo‐medial radius was identified on radiographic examination. The fragment was removed arthroscopically under general anaesthesia via a caudo‐medial approach to the elbow joint.     

Stratification,Blinding and Placebo Effect in a Randomized,Double Blind Placebo-controlled Clinical Trial of Gold Bead Implantation in Dogs with Hip Dysplasia

The purpose of this study was to investigate the need for and choice of stratification factors, and the effects of blinding and placebo in a clinical experiment. Eighty dogs with canine hip dysplasia (CHD) were included in a randomized, placebo-controlled and double blind clinical trial with stratified parallel group design, in which body weight and degree of CHD were used as stratification factors. Thirty-eight dogs were allocated to gold bead implantation and 42 to placebo. After six months, 33 of the 42 placebo-treated dogs received gold bead implantation in an open study lasting a further 18 months. The main outcome variable in the study was change in pain signs of CHD as assessed by the owner. No significant difference in the main outcome variable, regardless of the treatment given, could be detected in the two chosen stratification factors. The only factor to influence the main outcome variable significantly was age. The blinding procedure used in the study, in which 60% of the owners correctly guessed the treatment given, was found sufficient. Of those who guessed the treatment erroneously, 88% believed the treatment given was gold bead implantation. The treatment efficacy after six months in the blinded treatment group was found to be significantly larger compared to the efficacy obtained in the open study. A significant placebo effect was therefore detected. Conclusion and Clinical Relevance: The age of the dogs influenced the outcome of the CHD treatment, and is recommended as a stratification factor. A significant placebo effect has to be expected and an optimal blinding procedure is necessary in similar clinical studies.     

Topical hypertonic saline as a treatment for ocular and nasal hirudiniasis in a dog

This case report describes ocular and nasal leech infestation (hirudiniasis) in a dog. The patient presented for a suspected ocular foreign body. The patient was sedated to allow proper examination, which revealed a leech foreign body attached to the bulbar conjunctiva adjacent to the inferotemporal limbus of the left eye. A 3.5% hypertonic saline solution was applied topically to the eye in four sequential drops, until the leech detached itself and was removed with a cotton bud. The affected eye was found to have a small corneal ulcer, a small area of scleral haemorrhage, and prominent lymphoid follicles within the third eyelid. Approximately 5 min after the leech was removed, another leech emerged from the left nostril. The patient was sent home on chloramphenicol ointment for treatment of the corneal ulcer, was rechecked 4 days later by an American Board of Veterinary Ophthalmology resident (PM) and found to have a normal ocular exam. This case report highlights that topical hypertonic saline solution (3.5%) can be an effective and easily prepared treatment for ocular and nasal hirudiniasis in veterinary patients.     

Equine laryngeal dysplasia as a cause of acute respiratory distress in a neonatal foal

Equine laryngeal dysplasia (ELD) is a congenital disorder caused by hypoplasia or aplasia of the structures derived from the fourth and possibly sixth branchial arches. The severity of the clinical signs varies widely, and depends on which structures are involved and the extent of the defect. In most cases, affected horses present with abnormal respiratory noise during exercise and poor performance. Manifestation of the disease in foals is very rare. This case report describes an unusual presentation of ELD in a neonatal foal. The foal presented with severe respiratory distress and weakness. Equine laryngeal dysplasia was suspected on endoscopy and later confirmed on post mortem examination of the larynx. To the best of our knowledge, this is the first report describing ELD as a cause of respiratory distress in a neonatal foal.     

Closed reduction and surgical fixation of elbow joint luxation in an adult mare and in a 3-month-old foal using knotless bone anchors and FiberTape

This report describes the successful surgical stabilisation of elbow joint luxation using knotless bone anchors and FiberTape to repair the medial collateral ligament in an 11-year-old mare (Case 1) and both medial and lateral collateral ligaments in a 3-month-old foal (Case 2). Radiography (both cases) and computed tomography (Case 2) were used to diagnose subluxation (Case 1) and complete luxation (Case 2) with suspected rupture of both collateral ligaments. Case 1 was supported in a rescue sling for 7 weeks postoperatively to prevent recumbency. Recovery was good, and the mare was sound at the walk at the time of discharge 8 weeks after surgery and 1 year later at the follow-up visit. Case 2 was discharged 3 weeks after surgery and was sound at the trot when re-evaluated 2 and 6 months postoperatively. Although elbow luxation accompanied by torn collateral ligaments is rare in horses, successful outcomes have been described. In the present case report, joint stabilisation and a successful outcome were achieved, for the first time, with closed reduction and an open approach for placement of knotless bone anchors and FiberTape. Limitations of our study included inability to directly assess the integrity of the implants during healing and relying mainly on clinical signs to assess healing.     

Piroxicam and carboplatin as a combination treatment of canine oral non-tonsillar squamous cell carcinoma: a pilot study and a literature review of a canine model of human head and neck squamous cell carcinoma

Results of the treatment with a combination of carboplatin and piroxicam in seven dogs with advanced non‐tonsillar oral squamous cell carcinoma (SCC) were retrospectively analysed. This multi‐agent protocol was well tolerated by all dogs and resulted in a complete regression of the tumour without additional surgery in four of seven patients. Additional surgery was necessary to remove a metastatic lymph node in one dog and residual tumour in a second dog, which achieved a partial response following medical therapy. Median follow‐up for all the dogs was 534 days, while the time‐to‐recurrence, time‐to‐progression and overall survival for this group of patients have not yet been reached. Our study, although limited in number of animals, suggests that this multiagent approach is a useful treatment option for oral non‐tonsillarSCC in dogs and warrants wider application.