PURPOSE:: To evaluate the usefulness and safety of cone-beam computed tomography (CBCT) dacryocystography in detecting lesions, identifying coexisting soft-tissue changes and determining treatment options in patients with epiphora. PATIENTS AND METHODS:: Unilateral digital subtraction dacryocystography and CBCT dacryocystography were carried out on 45 patients. Stenoses and occlusions were identified and coexisting changes such as septal deviation and dacryoliths were noted. The diameter of the bony lacrimal duct of affected and unaffected side was measured and related to the clinically evident epiphora. An attempt was made to base the subsequent therapeutic planning on the CBCT dacryocystographic findings. Additionally, the radiation dose levels for CBCT dacryocystography in comparison to those of multislice computed tomography (MSCT) were evaluated in a standardized head-neck Rando-Alderson phantom. RESULTS:: Nasolacrimal duct obstructions were present in 37/45 patients, 18 with a stenosis and 19 with an occlusion in parts of the lacrimal outflow system. The minimal bony diameter of the side with epiphora was significantly decreased compared to the unaffected side. Coexisting soft-tissue changes did not correlate significantly with the clinical sign of epiphora. Eight patients showed no underlying reason for the epiphora and were treated conservatively. A total of eleven patients received interventional therapy for their stenosis and 23 patients had to be treated surgically. A further three patients received medical treatment for infection, before surgery and interventional therapy, respectively, were carried out. Dose levels for CBCT imaging remained far below those of MSCT. CONCLUSION:: CBCT dacryocystography is a safe and time-efficient modality for assessing the nasolacrimal duct system in patients with epiphora. CBCT dacryocystography provides detailed images of the nasolacrimal drainage system, surrounding soft tissue, and bony structures in one diagnostic tour. It allows clear measurement of the bony nasolacrimal duct and displays information beyond that of the drainage lumen, improving the planning of therapeutic interventional and surgical procedures.

We investigated the prevalence of an anatomic variant of the proximal femur, termed the broomstick-like femoral head and neck formation, and its influence on the Féderation Cynologique Internationale (FCI) hip dysplasia score in 294 German Shepherd dogs. One-hundred and eighty (61%) of the 294 dogs in our study had this anatomic variant. The calculated area of the femoral heads in dogs with a broomstick-like conformation was 4.5 +/- 0.6 cm2 on the hip-extended view. In dogs with a normal femoral head, the calculated area of the femoral head was significantly larger at 4.8 +/- 0.6 cm2 (P < 0.05). In the frog-leg view, there was no significant difference in femoral head area between dogs with the broomstick-like conformation and normal dogs. There was no difference in the antetorsion angle between dogs with broomstick-like conformation and normal dogs. There was also no difference in the distraction ratio between the two phenotypes. The official FCI hip score was similar in dogs with and without the broomstick-like conformation. The average heritability of the broomstick-like conformation was 0.3 +/- 0.1, suggesting heritable influence. We conclude that the broomstick-like conformation is a common finding in the German shepherd dog and has genetic base. The broomstick-like conformation does not appear to be associated with the presence of canine hip dysplasia and it can therefore be assumed to be a normal anatomic variant.

Lymph nodes are essential structures to be evaluated in an ultrasonographic examination of the feline abdomen. It was hypothesized that current technical proficiency would allow all feline abdominal lymph nodes to be identified ultrasonographically. Ten clinically normal, adult, domestic shorthair cats were examined using real-time compound ultrasonographic imaging. The medial iliac lymph nodes were visible in 100% of the cats, the jejunal lymph nodes in 90%, the hepatic lymph nodes in 70%, the aortic lumbar, the splenic, and the pancreaticoduodenal lymph nodes in 60% each, the ileocecal and the colic lymph nodes in 50% each, and the renal, the gastric, the sacral and the caudal mesenteric lymph nodes in 40%, 30%, 20%, and 10% of the cats, respectively. The inconsistent presence of lymph nodes, their poor echocontrast and interposed gas of the gastrointestinal tract explain the lower percentages of identification. The ultrasonographic length and diameter of the lymph nodes were determined. The majority of these measurements corresponded to those in the literature. We conclude that ultrasonography is a valuable tool for the identification and evaluation of most abdominal lymph nodes in the normal cat. Average ultrasonographic measurements are presented as a preliminary guideline for normal feline abdominal lymph nodes. ete

OBJECTIVE: Sutureless anastomoses for coronary artery surgery are being investigated for a minimally invasive setup because they are easy to perform and less time-consuming than are sutured anastomoses. The short-term effects of the biocompatible adhesive BioGlue on vascular tissue have been described as potentially unfavorable. The present study investigates the medium-term macroscopic and histologic effects associated with the use of BioGlue on rabbit carotid arteries. METHODS: Thirty-four carotid arteries of 17 New Zealand White rabbits were available. Nine carotid arteries were left unmanipulated and free of glue, 9 carotid arteries had BioGlue applied as a control, and 16 carotid arteries were transected and reanastomosed with the aid of BioGlue and an endovascular balloon. Of the 16 transected arteries, 4 had to be excluded from further evaluation. Angiographic scanning was performed 60 days postsurgery, after which the animals were euthanized and tissue samples were obtained for macroscopic and histologic examination. RESULTS: The application of BioGlue resulted in a marked invasion of inflammatory cells. The glue partially degraded and was replaced with connective tissue. Obvious calcification of the arterial wall and the capsule that had formed around the glue was present. Stenoses, thrombi, and pseudoaneurysms were predominantly noted in the glued anastomosis group. CONCLUSION: The results of this study raise concerns about the safety of BioGlue in coronary artery surgery. In light of our results, the use of BioGlue in large-vessel vascular surgery should be considered with great care for each individual patient.

BACKGROUND: In coronary artery bypass surgery the detection of the target vessels can be difficult due to their intramural location, coverage by adipose tissue, calcification, or fibrous tissue formation. Their identification is especially critical during off-pump coronary artery bypass (OPCAB) and minimally invasive direct coronary artery bypass (MIDCAB) surgeries. Our objectives were to identify whether (1) the epimyocardial use of the broadband linear array transducer CL15-7 allows a clear and rapid identification of the target artery during on-pump coronary bypass (CPB), OPCAB and MIDCAB surgeries; and (2) if this transducer is helpful in investigating the anastomotic morphology with 2D and color flow Doppler. METHODS: Thirty-two patients without a visually identifiable left anterior descending artery (LAD) were included in the study and epimyocardial ultrasonography was performed. Stabilization of the beating heart was used in 19 patients; in 13 patients, the surgery was carried out with CPB on the arrested heart. Two-dimensional ultrasound alone, or in combination with color Doppler, was used to identify the affected vessel as well as a suitable anastomosis site. Pulsed wave Doppler had to be used occasionally to differentiate between artery and vein. Patency of the anastomoses was established with color Doppler immediately after reinitiating blood flow. An evaluation of the distal graft diameter, its length, and the quality of the anastomosis was made with 2D and color Doppler. Transit-time Doppler flow was used to confirm patency. RESULTS: The LAD could be identified ultrasonographically in all 32 patients at a depth of 3 to 15 mm. The right coronary artery (RCA) was located at a depth of 3 to 10 mm in the 5 patients where this vessel was to be bypassed. The coronary arteries located on the lateral or posterior aspect of the heart could not be reached due to the shape and rigidity of the transducer handle. The intended anastomosis sites of the LAD and RCA were identified with ultrasound according to their topography and morphology. In all cases the vessel could be dissected and bypassed without undue damage or bleeding. In one OPCAB patient, the LAD was identified in close proximity to the overlying vein along the whole of the anterior wall. This resulted in conversion to CPB, thus facilitating secure exposure of the LAD. The ultrasonographic visibility of the left internal mammary artery to LAD and saphenous vein graft to RCA anastomoses was excellent, and patency correlated well with the transit time flow measurements. CONCLUSION: The CL15-7 transducer gives excellent near field visibility of the LAD and RCA. This is extremely valuable for the safe dissection of these vessels, especially during off-pump coronary surgery. The anatomical morphology of the anastomoses can be identified but, due to the shape of the transducer handle, only the coronary arteries on the anterior surface of the heart can be evaluated. A flexible, rather than a rigid, hockey stick-shaped handle would eliminate this problem. Training is essential to obtain reliable results.

BACKGROUND: Minimally invasive coronary artery surgery needs fast, reliable and easy methods of carrying out anastomoses. The aim of our study was to evaluate the use of BioGlue(R) in sutureless vascular anastomoses in the lapine model. METHODS: In 24 New Zealand white rabbits, 43 transsected carotid arteries were re-anastomosed using either a combination of balloon catheterisation and BioGlue(R) or a conventional suture. In five carotid arteries, only BioGlue(R) was applied. The animals were euthanised and tissue samples were taken for histological and immunohistological examination. RESULTS: A higher inflammatory cell infiltrate was present in the glue control and glue anastomosis groups, with the invasion of inflammatory cells located especially at the junction between the wall with and the wall without glue. Early calcification was detected in two arteries. CONCLUSION: The results of this short-term study show that the rabbit is an adequate as well as a sensitive model for the study of microanastomoses by glueing. Marked inflammatory reactions developed which may lead to vascular sclerosis or stenosis, and long-term studies are necessary to elucidate this problem further.

OBJECTIVE This study uses the concept of intergenerational ambivalence to compare the relationship of parents and their schizophrenic or substance dependent child to their relationship with the patient's siblings and to ordinary parent-child-relationships. METHOD 24 parents of schizophrenic patients, 19 parents of substance dependent patients and 38 parents of healthy adults were interviewed about ambivalences, satisfaction and relatedness within their parent-child-relationships. RESULTS Within both comparisons, parents experience in their relationship towards their mentally ill child stronger and more frequent ambivalences and less satisfaction, but feel equally strong related to him as to his sibling or as parents of healthy adults. This is especially true for parents of substance dependent adults. CONCLUSIONS Therapeutic professionals should keep in mind such intergenerational ambivalences and adress them in therapy and psychoeducation.

OBJECTIVES: To establish whether the intestinal wall thickness, as measured ultrasonographically, is significantly increased in dogs with inflammatory bowel disease (IBD). The results would provide the information necessary to decide whether measurement of ultrasonographic wall thickness can predict IBD in dogs. METHODS: The intestinal wall thickness of 75 dogs with idiopathic IBD, as measured by ultrasonography, was compared with recently published normal values. IBD was either confirmed histologically (n = 54) or suspected (n = 21). In all cases there was a positive response to immunosuppressive treatment. RESULTS: A positive association between intestinal wall thickness in dogs and either the histological diagnosis or the response to treatment was not found. Ultrasonographic intestinal wall measurements do not appear to be able to establish a diagnosis of intestinal inflammation and may result in a false negative diagnosis in cases of IBD. CLINICAL SIGNIFICANCE: The same 'grey zone' of between 4 and 6 mm used in humans can be used in the canine duodenum to distinguish the normal range, reserving the term 'abnormal' for an intestinal measurement greater than 6 mm in the duodenum and greater than 4.7 mm in the jejunum.

OBJECTIVES: Bipolar disorder is a severe, recurrent, and often highly impairing psychiatric disorder. The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) is a large-scale multicenter study funded by the National Institute of Mental Health (NIMH) to examine the longitudinal course of the disorder and the effectiveness of current treatments. The current report provides a context for interpreting studies resulting from STEP-BD by summarizing the baseline demographic and diagnostic characteristics of the first 1000 enrolled. METHODS: The majority of the sample met DSM-IV criteria for bipolar I disorder (71%). Mean age of patients was 40.6 (+/-12.7) years and mean duration of bipolar illness was 23.1 (+/-12.9) years. Among the first 1000 subjects enrolled, 58.6% are females and 92.6% Caucasian. This report compares the STEP-BD sample with other large cohorts of bipolar patients (treatment and community samples). RESULTS: Compared with US population and community studies, the first 1000 STEP-BD patients were less racially diverse, more educated, had lower income, and a higher unemployment rate. Results are discussed in terms of the contributions of STEP-BD (and other large-scale treatment studies) in understanding the nature, treatments, and outcomes of bipolar disorder for patients seeking care at academic treatment centers. CONCLUSIONS: The current report provides a context for interpreting future studies resulting from STEP-BD. The comparison of demographic and clinical characteristics between the samples across clinic-based studies suggests broad similarities despite the substantial differences in geography, payer mix, and clinical entry point.