Case report: Focal heterotopic ossification in paravertebral muscles as a cause of neurogenic lameness in a dog

This case report describes a 17-month-old Pudelpointer with recurring motor impairment localized to the left thoracic limb. A neurological exam highlighted lameness in that limb, accompanied by pre-scapular swelling. Radiographs and magnetic resonance imaging detected an osseous structure in soft tissues close to the fifth cervical vertebra, and subsequent surgery uncovered adjacent cervical spinal nerve impingement. Histology of the bony structure revealed heterotopic ossification in paravertebral muscles. Mild bone re-formation at the operating site was detected after a 2-year period, but the patient was asymptomatic. This article reports the first case of heterotopic ossification with spinal nerve entrapment in a dog and adds a new differential diagnosis to the causes of neurogenic lameness in dogs

NEJM -- Capturing the Unexpected Benefits of Medical Research

Remarkable advances have been made recently in our understanding of the molecular and genetic bases of disease. The potential therapeutic opportunities offered by these scientific findings, combined with the expanding needs of an aging population, have led to broad-based congressional support for increases in the National Institutes of Health budget. These developments have put into sharp relief the question of how to allocate growing budgetary resources among the various categories of medical research. In addition to the need to support basic-science research, investigators and policy analysts alike have recently emphasized the need to invest in translational research and clinical evaluative research. The rationale for supporting translational research, which is typically physiologic in nature, is that it is needed to convert the insights provided by basic biomedical science into new methods of diagnosis and therapy. 1 A case in point is the research that was based on fundamental observations about how renal tubules handle sodium and that led, in turn, to the development of new diuretic agents and methods of managing sodium imbalance. The argument for supporting clinical evaluative research is that it is needed to assess the efficacy and safety of such new interventions. There is, however, a much stronger rationale for the support of both types of research. Innovation is a learning process that takes place over time, and a fundamental aspect of learning is the reduction of uncertainty. The end of the research-and-development process does not entail the elimination of all, or even most, of the uncertainties surrounding medical innovation. Among these uncertainties are benefits that were unanticipated when the research was performed. Unanticipated uses of diagnostic and therapeutic interventions are often identified many years after their introduction. Indeed, widespread use is often an essential precondition for the identification of new applications, and clinical practice itself is thus a particularly important source of medical innovation. The unexpected and anomalous results of clinical experience thus pose new questions for basic biomedical research and enrich its ultimate payoff. What measures might be taken to broaden the range of indications for new therapies and to accelerate their discovery and introduction? Should these measures be publicly or privately financed? It took half a century for the cardiovascular benefits of aspirin, the most widely used drug in the world, to be recognized and nearly 40 more years before it was widely used for cardiovascular indications. Could this process have been expedited? To address these questions, it is necessary to examine the pathways by which new indications for therapies are discovered. Why Uncertainty Endures Successful research and development puts an end to some uncertainties but opens the gate to others, not for want of methodologic acumen, but because the complexity of humans limits the ability to predict the effect of a new intervention. Alpha-adrenergic-receptor antagonists, for instance, were first tested for hypertension