Skull pathology in 10 cats with patellar fracture and dental anomaly syndrome

Case series summary: The aim of this case series is to describe the clinical and radiological features of mandibular and maxillary abnormalities in cats diagnosed with patellar fractures and dental anomalies, a condition that we have named ‘patellar fracture and dental anomaly syndrome’ (PADS), also known previously as ‘knees and teeth syndrome’. Where available, clinical records, skull and/or intraoral dental radiographs, head CT images, microbiology and histopathology reports were collected, and follow-up was obtained. Ten cats with mandibular or maxillary abnormalities were identified. Common clinical features included multiple persistent deciduous teeth, gingivitis and swellings of the jaw. Skull radiographs were available for 7/10 cats and head CT images were available for one cat. Findings included marked bony and periosteal proliferation, hypodontia, root resorption, root malformation and unerupted permanent teeth. Where available, microbiology and histopathology results were consistent with osteomyelitis. Relevance and novel information: Mandibular and maxillary abnormalities are an additional unreported clinical feature of the rare condition that we have termed PADS. Radiologically, these lesions can have an aggressive appearance, which can mimic neoplasia. Medical management with antibiotic and anti-inflammatory therapy improves clinical signs in the short term; however, surgical extraction of persistent deciduous and unerupted permanent teeth, and debridement of proliferative and necrotic bone appear to be necessary for an improved outcome. Additional information on long-term outcome is required

Process of medical malpractice risk allocation in the Italian public health systems

This paper is aimed at analysing the key issues of the process of medical malpractice risk allocation in the Italian public health system. We introduce the function of liability insurance and we discuss also the problems related to optimal coverage design. We then turn to the empirical section thanks to a large database which includes all the information contained in 308 tender notices concerning the acquisition of RCT/O coverage by the Italian local public health firms between 2003 and 2006. The analysis of the data collected provides a first assessment of i) the ability of the Italian public sector to find risk coverage on the private insurance market, ii) the dynamics of prices and market power of insurance firms, and iii) the role of insurance brokers. We propose two alternative scenarios which explain the proposed empirical evidence

Motion characteristics of the human TMJ during border movements: a preliminary study

Purpose. Unambiguous evidence of pure rotation of a mandible put in CR position has never been provided in living subjects. The hypothesis of this investigation was that there are no significant differences, owing to the intervention of different operators, between acquisitions. The aim of this work was to validate our acquisition protocol to quantify the contribution of different operators to the CR movements. Methods. Five male adults volunteered for this study. Mandibular movements of open-close, laterotrusion and protrusion were recorded via an optoelectronic device. Four acquisitions for each subject were made from an operator induced CR starting position, another four from ICP. Two different operators put the subjects in CR. For each subject, the mandibular motions were cleaned from external movements, the motions of the interincisor point were reconstructed and the rotational component was calculated in particular in the instants of maxima. Results. For every considered movement, the influence of the operator in putting each subject in CR was negligible. Between CR and ICP movements no significant. differences in the points of maxima were found regarding the percentage contribution of rotation, this contribution in CR movements was never exhaustive. Clinical significance. The protocol for the detection of mandibular movements may be considered repeatable and thus be used to perform deeper analysis on the considered movements in an attempt to find a scientific basis to the use of CR mounted models

Efficacy and side effects of radiation therapy in comparison with radiation therapy and temozolomide in the treatment of measurable canine malignant melanoma.

Prognosis for unresectable canine malignant melanoma (MM) is typically poor, and therapeutic approaches remain largely palliative. A bi-institutional trial was conducted to compare efficacy and safety of radiation therapy (RT) and RT with post-radiation temozolomide in dogs with chemotherapy-na\uefve, measurable MM. RT consisted of 5\u2009 7\u20096 Gy fractions over 2.5\u2009weeks. Dogs whose owners wished to pursue chemotherapy received adjuvant oral temozolomide (60\u2009mg\u2009m-2 for 5\u2009days every 28\u2009days). Fifteen dogs were treated with RT only (Group 1) and 12 dogs subsequently received temozolomide (Group 2). Overall response rate was similar between Group 1 (86.7%) and Group 2 (81.1%). Median time to progression (TTP) was significantly longer in Group 2 (205\u2009days) compared to Group 1 (110\u2009days; p\u2009=\u20090.046). Survival time was not significantly different between groups. Both treatments were well tolerated. Post-radiation temozolomide has a good safety profile, and may improve TTP in MM when compared to coarse fractionated RT

Efficacy and side effects of radiation therapy in comparison with radiation therapy and temozolomide in the treatment of measurable canine malignant melanoma

Prognosis for unresectable canine malignant melanoma (MM) is typically poor, and therapeutic approaches remain largely palliative. A bi-institutional trial was conducted to compare efficacy and safety of radiation therapy (RT) and RT with post-radiation temozolomide in dogs with chemotherapy-naive, measurable MM. RT consisted of 5 x 6 Gy fractions over 2.5weeks. Dogs whose owners wished to pursue chemotherapy received adjuvant oral temozolomide (60 mg m(-2) for 5 days every 28 days). Fifteen dogs were treated with RT only (Group 1) and 12 dogs subsequently received temozolomide (Group 2). Overall response rate was similar between Group 1 (86.7%) and Group 2 (81.1%). Median time to progression (TTP) was significantly longer in Group 2 (205 days) compared to Group 1 (110 days; p=0.046). Survival time was not significantly different between groups. Both treatments were well tolerated. Post-radiation temozolomide has a good safety profile, and may improve TTP in MM when compared to coarse fractionated RT

Efficacy and side effects of radiation therapy in comparison with radiation therapy and temozolomide in the treatment of canine malignant melanoma.

Introduction. In dogs, malignant melanoma (MM) is notorious for its propensity to metastasize and for its poor response to current therapeutic regimens. Better tolerated, less toxic, and more efficacious treatments are needed. Material and methods. Dogs with newly diagnosed or recurrent, histologically confirmed MM of any clinical stage were prospectively enrolled to investigate objective response, time to progression (TTP), and overall survival as well as the safety profile of radiation therapy (RT) in comparison with RT and temozolomide. The RT protocol consisted of 5 fractions of 6 Gy to a total dose of 30 Gy over 2,5 weeks. Dogs whose owners wished to pursue chemotherapy received adjuvant oral temozolomide (60 mg/m2/die for 5 days). Treatment cycles were repeated every 28 days for 4 cycles. Results. Fifteen dogs were treated with RT (Group 1) and 11 dogs were irradiated and subsequently treated with temozolomide (Group 2). Response rate was 73.3% (3 complete remissions [CR], 8 partial remissions [PR]) in Group 1, and 72.7% (2 CR, 6 PR) in Group 2. Median TTP was not significantly different among groups. When considering survival time, dogs in Group 2 lived significantly longer than dogs in Group 1 (p = 0.094). Toxicity was similar between groups. Conclusion. Conventionally fractionated RT followed by 4 cycles of temozolomide has a good safety profile and increases survival time in dogs with MM. These results warrant future randomized trials to further explore the role of adjuvant temozolomide, and support the general concept of combining radiation therapy with radioenhancing chemotherapeutic agents