Myopathie der Labrador Retriever: neuromuskuläre Veränderungen bei kranken und klinisch gesunden Hunden

Gegenstand und Ziel: Die erbliche Myopathie der Labrador Retriever (LM) ist eine autosomal rezessive Krankheit, die bei schwarzen und gelben Tieren beiderlei Geschlechts und unterschiedlichen Alters vorkommt. Um der Frage nachzugehen, welche Rolle die LM in der hiesigen Labradorpopulation spielt, wurden seit 1998 am Institut für Neuropathologie der Universität Düsseldorf Muskel-und Nervenbiopsien von 121 Labrador Retrievern untersucht. Hunde: Die Tiere gehörten zu zwei Untersuchungsgruppen. Gruppe I (Einsendungen) umfasste 63 Labrador Retriever unterschiedlicher Herkunft aus Deutschland, Schweiz, Italien und Portugal mit Symptomen einer Myopathie. Gruppe II (Zuchttiere): Im Rahmen einer genetischen Studie wurden 58 miteinander verwandte Labrador Retriever aus einer Zucht in der Schweiz untersucht, nachdem dort bei zwei Welpen LM nachgewiesen worden war. Ergebnisse: Gruppe I: 17/63 (27%) hatten eine degenerative Myopathie vom Typ der Labrador-Myopathie, 8/63 (13%) metabolisch-mitochondriale Veränderungen, 33/63 (52%) andere (überwiegend neurogene oder entzündliche) Myopathien und bei 5/63 (8%) wurden keine pathologischen Veränderungen in Muskel und/oder Nerv nachgewiesen. Gruppe II: Zwar hatten nur sieben Tiere der Zucht klinische Symptome, doch wies die Mehrzahl morphologisch und histochemisch nachweisbare neuromuskuläre Veränderungen auf, nämlich 37/58 (64%) solche vom Typ der LM, darunter auch die Eltern und die sieben Geschwister der beiden Welpen, und 11/58 (19%) vorherrschend metabolisch-mitochondriale Veränderungen. Schlußfolgerungen: Die vorliegende Untersuchung zeigt, dass (a) die Verbreitung der erblichen Myopathie und deren Erfassung ein ernst zu nehmendes Problem beim Labrador Retriever darstellt und (b) neben der »klassischen« erblichen Typ-2-Myopathie der Labrador Retriever möglicherweise noch eine zweite, metabolisch-mitochondriale Form der Myopathie besteht, die Ähnlichkeiten mit einer anstrengungsabhängigen Myopathie bei Labrador Retrievern in den USA aufweist.

C-Arm Cone-Beam CT Combined with a New Electromagnetic Navigation System for Guidance of Percutaneous Needle Biopsies: Initial Clinical Experience

PURPOSE

To evaluate the feasibility and efficacy of C-arm fluoroscopic cone-beam computed tomography (CACT) in combination with a new electromagnetic tracking (EMT) system for needle guidance during percutaneous biopsies.

MATERIALS AND METHODS

53 patients were referred for biopsy of thoracic (n = 19) and abdominal (n = 34) lesions. CT-like images of the anatomical region of interest (ROI) were generated using a flat panel-based angiographic system. These images were transmitted to an EMT system. A coaxial puncture needle with a sensor in its tip was connected with the navigation system and tracked into an electromagnetic field created via a field generator. Data generated within this field were merged with the CACT images. On a monitor both the anatomical ROI and needle tip position were displayed to enable precise needle insertion into the target. Through the coaxial needle, biopsy specimens for the histologic evaluation were extracted. Number of representative biopsy samples, number of core biopsies/patient, total procedure time, dose-area product, fluoroscopic time, and complications were recorded.

RESULTS

53 CACT/EMT-guided biopsy procedures were performed, 48 of which (91 %) yielded representative tissue samples. Four core biopsies were obtained from each patient. 40 (75 %) lesions were malignant and 13 (25 %) lesions were benign. The total procedure time was 9 ± 5 min (range, 3 - 23 min), fluoroscopic time was 0.8 ± 0.4 min (range, 0.4 - 2 min). The mean dose-area product (cGy cm²) was 7373 (range, 895 - 26 904). The rate of complications (1 pneumothorax, 2 hemoptyses) was 6 %.

CONCLUSION

CACT combined with EMT appears to be a feasible and effective technique for the guidance of percutaneous biopsies with a low rate of therapeutically relevant complications.

KEY POINTS

• Guidance of percutaneous biopsies with a combination of CACT and EMT is technically feasible. • CACT/EMT-guided biopsies are associated with a good diagnostic yield. • The rate of complications appears to be low for this guidance technique.

[Classification and therapy of vasculitis according to recommendations of the European League Against Rheumatism (EULAR)]

Vasculitis is still being classified according the criteria of the American College of Rheumatology and the Chapel Hill Consensus Conference Definitions. Diagnostic criteria are currently being established. The classification criteria are based on the size of the inflamed blood vessel (e.g. large vessel vasculitis with inflammation of the aorta and its branches), clinical symptoms and findings (such as cephalalgia in giant cell arteritis) and histological findings. In recent years a definition of disease stages and activity has been established and a number of controlled trials have been carried out in order to provide evidence-based stage and activity adapted therapy regimens. Recommendations for the management of vasculitis have been published in 2009 by EULAR (European League Against Rheumatism). This article gives a review of the classification of vasculitis and summarizes the current European guidelines on management.

Distal phalangeal bone cysts: differentiation of enchondromata and epidermal cysts

Enchondromas are common in the hand but less frequent in the distal phalanges. Epidermal cysts are rare in the hand but when they occur can be difficult to differentiate from enchondromas both clinically and radiologically. Our review of seven distal phalangeal bone lesions treated over 7 years included four enchondromas and three epidermal cysts. The patients with epidermal cysts all had a history of previous penetrating trauma 5-8 years earlier. One patient with an enchondroma had a history of a penetrating injury. Patients presenting with distal phalangeal lesions and a history of previous penetrating injury appear more likely to have an epidermal cyst than an enchondroma. This is important as there may be a higher recurrence rate following curettage and bone grafting.