Diagnosis of Congenital Cardiac Right-to-left Shunts with 99mTc-macroaggregated Albumin

Diagnosing right-to-left congenital cardiac shunts can be difficult. Cardiac catheterization and angiocardiography represent the traditional gold standard for diagnosis, but they are invasive. Nuclear scintigraphy using 99mTc-macroaggregated albumin (MAA) has been employed in humans as an alternate method of diagnosis. This study reviews eight dogs presented for evaluation of a suspect right-to-left cardiac shunt that were examined using 99mTc-MAA. In all, 2-4 mCi (74-148 MBq) of reduced particle 99mTc-MAA were injected IV in a cephalic vein and static images of the whole body, including right and left lateral, dorsal, and ventral views, were acquired for 60 s and stored into a 256 x 256 x 16 matrix. Shunt fractions were calculated. One dog with radiopharmaceutical distribution limited to the lungs did not have a shunt. Seven dogs had distribution of the radiopharmaceutical outside the pulmonary capillary bed, indicating bypassing of the pulmonary capillary circulation due to a right-to-left shunt. Four dogs had 99mTc-MAA within the brain. Three dogs that did not have brain uptake, but instead had a sharp cutoff of radioactivity at the level of the front limbs and neck, were diagnosed with reverse patent ductus arteriosus (PDA). The asymmetric distribution of the radiopharmaceutical is due to the location of the shunt, distal to the brachiocephalic trunk and left subclavian artery. Shunt fractions of dogs with extrapulmonary radioactivity ranged from 40% to 59%. Nuclear scintigraphy with 99mTc-MAA is a quick alternative method of diagnosing right-to-left cardiac shunts that permits quantification of shunt fraction. Distinguishing between reverse PDA and other right-to-left shunts may be possible based on the radiopharmaceutical distribution.     

Application of Airway Pressure Therapy in Veterinary Critical Care: Part I: Respiratory Mechanics and Hypoxemia

Over the past several decades, recognition of acute respiratory failure as the cause of death in patients suffering from various clinical conditions has prompted aggressiv investigation into the area of respiratory physiology and supportive respiratory care. With the evolution of emergency medicine and critical care services in both human and veterinary medicine, many patients previously considered unsalvageable due to the severity of their underlying disease are now being resuscitated and successfully supported, creating a new population of critically ill patients. Where only a decade ago these patients would have succumbed to their underlying disease, they now survive long enough to manifest the complications of shock and tissue injury in the form of acute respiratory failure. Investigation into the pathophysiology and treatment of this acute respiratory distress syndrom (ARDS) has facilitated increased clinical application of respiratory theerapy and machanical ventilation.¹ The purpose of this paper is to provide a basic review of respiratory mechanics and the pathophysiology of hypoxemia as they relate to airway pressure therapy in veterinary patients and to review the use of airway pressure therapy in veterinary patients This paper is divided into two parts; part I reviews respiratory mechanics and hypoxemia as they apply to respiratory therapy, while part II deals specifically with airway pressure therapy andits use in clinical cases.     

Intra-specific variation of wheat grain quality in response to elevated [CO2] at two sowing times under rain-fed and irrigation treatments

In order to investigate the intra-specific variation of wheat grain quality response to elevated atmospheric CO₂ concentration (e[CO₂]), eight wheat (Triticum aestivum L.)cultivars were grown at two CO₂ concentrations ([CO₂]) (current atmospheric, 389 CO₂ μmol mol⁻¹vs. e[CO₂], FACE (Free-Air CO₂ Enrichment), 550  ±  10% CO₂ μmol mol⁻¹), at two water levels (rain-fed vs. irrigated) and at two times of sowing (TOS₁, vs. TOS₂). The TOS treatment was mainly imposed to understand whether e[CO₂] could modify the effects of timing of higher grain filling temperatures on grain quality. When plants were grown at TOS₁, TKW (thousand kernel weight), grain test weight, hardness index, P, Ca, Na and phytate were not significantly changed under e[CO₂]. On the other hand, e[CO₂] increased TKW (16%), hardness index (9%), kernel diameter (6%), test weight (2%) but decreased grain protein (10%) and grain phytate (11%) at TOS₂. In regard to grain Zn, Mn and Cu concentrations and some flour rheological properties, cultivar specific responses to e[CO₂] were observed at both sowing times. Observed genetic variability in response to e[CO₂] in terms of grain minerals and flour rheological properties could be easily incorporated into future wheat breeding programs to enable adaptation to climate change.     

Growth and feed utilization by yearling horses fed added dietary fat

Twenty-four yearlings were used to evaluate the efficacy of feeding feed-grade fat to growing horses. All horses were started on trial at 13-months-of-age and were fed for 112 days. The experimental diets, containing similar nutrient-to-calorie ratios, were: 1) control (no added fat; 2) 5% added fat and; 3) 10% added fat. There was a trend for yearlings fed the 10% added fat diet to grow faster and eat less feed than those on the control diet. Data from this study indicate that feed-grade fat can be safely fed to growing horses. Feeding fat to yearlings stimulated growth and efficiency of feed utilization initially, but these effects were not maintained as the yearlings grew toward maturity.     

Potential Iatrogenic Medial Meniscal Damage During Tibial Plateau Leveling Osteotomy

Objective— To evaluate potential iatrogenic medial meniscal (MM) damage during tibial plateau leveling osteotomy (TPLO) and to establish a safe zone (SZ) for hypodermic needle (HN) identification of the medial aspect of the stifle joint.
Study Design— Prospective cohort.
Animals— Cadaveric canine stifles (n=40).
Methods— HN (20 or 25 G) were inserted through the medial collateral ligament (MCL) of the femorotibial joint and through the SZ insertion points. The medial meniscus was inspected for iatrogenic damage. Statistical comparison of MM damage caused by different needle sizes and insertion sites was performed using Fisher's exact test with significance at P <.05.
Results— Twenty-gauge group: 65% of stifles had minor MM damage with MCL insertion compared with 35% of stifles with SZ insertion ( P =.0049). Severe MM damage occurred in 25% of stifles with MCL insertion compared with 0% of stifles with SZ insertion ( P =.0014). Twenty-five-gauge group: 85% of stifles had minor MM damage with MCL insertion compared with 30% after SZ insertion ( P =.0011); however, no severe MM injury was noted.
Conclusions— HN insertion though the MCL can produce iatrogenic damage to the MM. Use of a 25 G HN and SZ site for insertion reduced the frequency and severity of MM damage.
Clinical Relevance— HN insertion into the medial aspect of the femorotibial joint during TPLO can cause gross iatrogenic MM damage, which may contribute to the incidence and misdiagnosis of latent MM injuries after TPLO.     

Biomechanical Comparison of the Trocar Tip Point and the Hollow Ground Tip Point for Smooth External Skeletal Fixation Pins

Objective —To compare the insertional characteristics of external fixator pins with hollow ground (HG), modified HG, and trocar (T) points.
Study Design —An acute, in vitro biomechanical evaluation.
Sample Population—Thirteen radii from canine cadavers.
Methods —A total of 16 T-tipped and 16 HG-tipped pins were inserted into 8 canine radii. Ten pins of each modification of the HG tip (length of the cutting edge reduced by 0.127 mm and 0.254 mm, respectively) were inserted into another five radii. All pins were inserted with low-speed power drilling and 80 N drilling load. Differences between peak tip temperature, drilling energy, and pullout force were determined for each pin type at both diaphyseal and metaphyseal locations.
Results —HG-tipped pins showed a 40% lower tip temperature in diaphyseal bone, a 25% reduction in drilling energy in diaphyseal bone, and a reduction of pullout force in both diaphyseal (65%) and metaphyseal (50%) bone compared with T-tipped pins. HG 0.254-mm pins generated higher tip temperatures and had greater pullout than HG pins in diaphyseal bone.
Conclusions —The HG tip was a more efficient design; however, the reduction in pullout force suggests that, because a better hole was drilled, radial preload is reduced. Reduction of the cutting edge by 0.254 mm increased the pullout force but also increased the temperatures.
Clinical Relevance —Thermal and microstructural damage are reduced by the HG tip, but pin-bone interface stability is also compromised. The use of a tip with 0.254 mm reduction in the cutting edge may optimize the biological and mechanical factors at the pin-bone interface.