Portosystemic shunts in dogs and cats: definition, epidemiology and clinical signs of congenital portosystemic shunts

SAMENVATTING Congenitale portosystemische shunts (CPSS) zijn hepatische bloedvatafwijkingen die bij elk honden-of kattenras kunnen voorkomen. Extrahepatische CPSS komen vooral voor bij kleine honden en katten, terwijl intrahepatische CPSS vooral grote hondenrassen aantasten. Voor sommige hondenrassen is een erfelijke basis vastgesteld. Aangetaste dieren worden meestal op jonge leeftijd aangeboden met variërende neurologische, gastro-intestinale, urinaire of andere klachten. Symptomen te wijten aan hepatische encefalopathie nemen dikwijls de overhand. De pathogenese van dit syndroom is tot nu toe nog niet volledig gekend en is vermoedelijk multifactorieel. De onderliggende oorzaak is vermoedelijk de invloed op de hersenen van één of meerdere toxinen die normaal gezien door de lever ontgiftigd zouden moeten worden. Katten met CPSS vertonen zeer vaak ptyalisme

Comparison of contrast-enhanced multidetector computed tomography angiography and splenoportography for the evaluation of portosystemic-shunt occlusion after cellophane banding in dogs

BACKGROUND Many patients with a congenital extrahepatic portosystemic shunt (PSS) do not tolerate an immediate shunt closure. Therefore, slow progressive techniques were developed. To evaluate the success of shunt closure diagnostic imaging is essential to identify possible residual blood flow through the shunt vessel. There is a lack of information about the reliability of computed tomography angiography (CTA) for evaluating residual flow through a PSS after treatment. The purpose of this prospective study was to compare the results of CTA with splenoportography. Three months after cellophane banding CTA and splenoportography were performed in 20 dogs and reviewed by three independent examiners, respectively. In both imaging modalities the presences of a residual shunt was judged as present or absent and the extent of visibility of portal vasculature was recorded. RESULTS Based on the evaluation of the splenoportography residual flow through shunt was present in 6 dogs. The classification of residual shunt present or absent showed a substantial to perfect agreement (κ = 0.65-1.00) between the observers in splenoportography and a slight to moderate agreement (κ = 0.11-0.51) for CTA. Sensitivity and specificity varied between 0.50 and 1.00 and 0.57-0.85, respectively. Significant correlation between CTA and splenoportography for the classification of residual shunt was present only in one observer but not in the other two. CONCLUSION More studies were classified as residual shunt positive with CTA compared to splenoportography. It remains unclear which methods do reflect reality better and thus which method is superior. The greater inter-rater agreement for splenoportography suggests a greater reliability of this technique

Oral health of Chinese people with systemic sclerosis

The aim was to study oral health status, salivary function, and oral features of Chinese people with Systemic Sclerosis (SSc). Chinese people with SSc attending a university specialist clinic were invited for a questionnaire survey and a clinical examination. Ethics approval was sought (UW 08-305). Gender- and age-matched individuals without SSc who attended a university dental hospital were recruited for comparison. Forty-two SSc patients with a mean age of 54.0 ± 12.2 were examined. This study found no Chinese people with systemic sclerosis were periodontally healthy and many (76%) had periodontal pockets despite most of them (93%) practiced daily tooth-brushing. They all had caries experience (DMFT = 10.5) and many (65%) had untreated decay. Mucosal telangiectasia was a common oral feature (80%). They had lower resting salivary flow rates (0.18 ± 0.17 ml/min vs. 0.31 ± 0.21 ml/min; p = 0.003) and pH values (6.90 ± 0.40 vs. 7.28 ± 0.31; p < 0.001) and reduced maximal mouth opening (40.1 ± 6.5 mm vs. 43.6 ± 7.0 mm) than people without SSc

Biodegradable self-reinforced poly-L/DL-lactide plates and screws in bimaxillary orthognathic surgery: short term skeletal stability and material related failures.

Biodegradable self-reinforced poly-L/DL-lactide plates and screws were used for osteosynthesis in 10 consecutive cases of bimaxillary procedures with simultaneous genioplasties, without postoperative rigid intermaxillary fixation. During surgery, data were gathered concerning failure of the osteosynthesis material. Clinical examination was carried out weekly until the sixth postoperative week. Cephalometric analysis of standardized cephalograms was performed to evaluate the short-term skeletal stability pattern, which was compared with similar reports in the literature. Six weeks postoperatively, all jaws were clinically stable and there was no clinical evidence of foreign body reactions. For the whole group (n = 10), the mean maxillary advancement at point A was 2.9 mm with a mean postoperative relapse of 0.0 mm. The mean advancement at point B was 2.8 mm with a mean additional advancement postoperatively of 1.1 mm. The mean vertical surgical displacement at point A was directed inferiorly with a value of 1.8 mm and a relapse of -0.4 mm. At point B the corresponding values were 1.9 mm and -0.4 mm. In the Angle Class III group (n = 4), the mean advancement at A was 5.9 mm with an additional postoperative advancement of 0.3 mm. In the Angle Class II group (n = 6), mean advancement at point B was 4.0 mm, with an additional postoperative advancement of 1.1 mm. In the group with short face deformity (n = 3), the mean inferior movement in ANS was 6.6 mm with a relapse of -0.2 mm. At menton the vertical surgical movement was 13.0 mm with a relapse of -0.2 mm. None of the plates, which were bent at room temperature, broke. The screw heads broke or had an insufficient fit in the bone in 12 of 305 (3.9%) screws. It can be concluded that the tested system of biodegradable self-reinforced poly-L/DL-lactide screws and plates has a small material-related failure rate, and that their application in orthognathic surgery leads to a predictable short-term skeletal stability pattern which is comparable to the 'gold standard' of titanium plates and screws

Comparison of three methods of facial measurement

The aims of this study were to assess the accuracy of measurements recorded by 3D stereophotogrammetry and to compare three methods of facial measurement: manual anthropometry, 3D stereophotogrammetry and 2D photography. Measurements were taken from 14 landmarks on each of six volunteers and compared. In addition, the variability of the methods was assessed. Three-dimensional measurements were shown to compare well with manual measurements on volunteers as well as test objects for which the mean difference was 0.23 mm (shortest distance) and 0.13 mm (surface). All the three methods of measurement were found to have good levels of repeatability. Two-dimensional measurements were more variable than manual measurements (P=0.021). Three-dimensional stereophotogrammetric measurements were shown to compare well with manual measurements although the values obtained were mostly slightly larger. Stereophotogrammetry allows images to be taken in a Medical Photography Department, facilitating the accurate measurement of facial morphology from digitized data, including changes associated with treatment or growth. There are clear potential benefits of using 3D measurements in the assessment of facial deformity

The Le Fort I osteotomy as a surgical approach for removal of tumours of the midface.

Tumours of the midface and maxillary sinuses have been removed via multiple approaches. The most common approaches are those using incisions in the facial skin, especially in the case of malignant tumours. The Le Fort I procedure via an intraoral incision as described by Sailer in 1986 is a versatile alternative. Combined with a coronal approach and various osteotomies of the upper face it also allows removal of tumours extending into the orbits, the nasoethmoidal complex and the skull base. The versatility of the Le Fort I osteotomy as a surgical approach was analysed in 17 cases. This method is reliable and gives excellent access. Further advantages are the wide surgical exposure and the clear visibility of the resection margins, the absence of visible scars, the feasibility of combining this approach with reconstruction using the buccal fat pad and the possibility of simultaneous placement of bone grafts, insertion of endosseous implants or other preprosthetic procedures via the same incision

The role of a posteriorly inclined condylar neck in condylar resorption after orthognathic surgery.

Recently, it has been reported that a posteriorly inclined condylar neck is associated with condylar resorption following orthognathic surgery, although its role in resorption remains unknown. By cephalometric screening of 240 patients with Angle Class II occlusion 2 years after orthognathic surgery, 11 patients with postoperative condylar resorption were identified. The preoperative posterior inclination of the condylar neck and the surgical risk factors mentioned in the literature, particularly surgically induced counterclockwise rotation of the mandibular proximal segment were evaluated. In all 11 cases, the condylar neck was clearly inclined posteriorly. Counterclockwise rotation of the proximal segment was also observed in all cases, and it amounted to 6.7 degrees (2.5-12 degrees) on average. The contributing role of a posteriorly inclined condylar neck in connection with surgical mandibular movement in postoperative condylar resorption is discussed