Initial and serial AFAST with applied AFS allowed rapid, semiquantitative measure of free abdominal fluid in traumatized patients, was clinically associated with severity of injury, and reliably guided clinical management. Where possible, AFAST and AFS should be applied to the management of blunt trauma cases.
Objective: To estimate the relative accuracy of a thoracic focused assessment with sonography for trauma (TFAST) protocol for rapid diagnosis of pneumothorax (PTX) and other thoracic injury in traumatized dogs. Design: Prospective case series. Setting: Private veterinary emergency center. Animals: One hundred and forty-five client-owned dogs evaluated within 24-hours of injury. Interventions: Thoracic focused assessment with sonography for trauma protocol. Measurements and Main Results: Traumatized dogs were evaluated with a conventional ultrasound (US) machine using a standardized 4-point thoracic FAST protocol before thoracic radiography (CXR) and thoracocentesis. PTX was diagnosed by the absence of the 'glide sign,' defined as the lack of the normal dynamic interface between lung margins gliding along the thoracic wall during respiration. Concurrent thoracic trauma was diagnosed by the presence of pleural or pericardial fluid or the presence of a 'step sign,' defined as an abnormal glide sign. Accuracy of TFAST was calculated relative to CXR findings. Results: Overall sensitivity (Se), specificity (Sp), and accuracy of TFAST relative to CXR were 78.1% (95% CI; 61.5, 89.9), 93.4% (95% CI; 87.4, 97.1), and 90.0%, respectively. Se and Sp were higher in dogs with penetrating trauma (93.3%, 96.0%) and for the evaluator with the most clinical experience (95.2%, 96.0%); only Se between the most experienced compared with others was statistically significant (Po0.05). TFAST documented other concurrent thoracic injury. Median time for TFAST was 3 minutes. Conclusions and Clinical Relevance: TFAST has the potential to rapidly diagnose PTX and other thoracic injury and guide therapy, including potentially life-saving interventions, in traumatized dogs.
Radioactive copper (II) (diacetyl-bis N4-methylthiosemicarbazone) (Cu-ATSM) isotopes were originally developed for the imaging of hypoxia in tumors. Because the decay of a 64Cu atom is emitting not only positrons but also Auger electrons, this radionuclide has great potential as a theranostic agent. However, the success of 64Cu-ATSM internal radiation therapy would depend on the contribution of Auger electrons to tumor cell killing. Therefore, we designed a cell culture system to define the contributions to cell death from Auger electrons to support or refute our hypothesis that the majority of cell death from 64Cu-ATSM is a result of high-LET Auger electrons and not positrons or other low-LET radiation. Chinese hamster ovary (CHO) wild type and DNA repair–deficient xrs5 cells were exposed to 64Cu-ATSM during hypoxic conditions. Surviving fractions were compared with those surviving gamma-radiation, low-LET hadron radiation, and high-LET heavy ion exposure. The ratio of the D10 values (doses required to achieve 10% cell survival) between CHO wild type and xrs5 cells suggested that 64Cu-ATSM toxicity is similar to that of high-LET Carbon ion radiation (70 keV/μm). γH2AX foci assays confirmed DNA double-strand breaks and cluster damage by high-LET Auger electrons from 64Cu decay, and complex types of chromosomal aberrations typical of high-LET radiation were observed after 64Cu-ATSM exposure. The majority of cell death was caused by high-LET radiation. This work provides strong evidence that 64Cu-ATSM damages DNA via high-LET Auger electrons, supporting further study and consideration of 64Cu-ATSM as a cancer treatment modality for hypoxic tumors.
The lack of B-lines in cats without respiratory disease (with radiographically normal lungs) and the predominance of B-lines in cats with left-sided CHF suggest that a regionally based LUS protocol may be clinically useful for the identification and evaluation of feline respiratory conditions.
Fluorine-18-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) provides physiologic images of tissues based on their glucose metabolism. The combination of FDG PET and CT (FDG PET-CT) has been utilized in human musculoskeletal imaging to localize soft tissue lesions, however, this modality has not been thoroughly investigated for the diagnosis of canine lameness. This prospective, descriptive study evaluated FDG PET-CT findings in 25 client-owned dogs with inconclusive origin of thoracic or pelvic limb lameness (thoracic limb n = 15/25, 60%; pelvic limb n = 6/25, 24%; and combination of both limbs n = 4/25, 16%). We hypothesized that FDG PET-CT would aid the detection of soft tissue lesions not visible with other imaging modalities. Combined FDG PET-CT detected soft tissue lesions in 40% (n = 10/25) and osteoarthritis in 64% (n = 16/25) of the patients. FDG PET detected more soft tissue lesions than contrastenhanced CT (n = 15/15, 100% and n = 12/15, 80%, respectively), while CT identified more osteoarthritis lesions than FDG PET (n = 26/26, 100% and n = 18/26, 69%, respectively). The three imaging-diagnoses based on the FDG PET component included the following: flexor carpi ulnaris muscle tear, psoas major myopathy, and tarsal desmopathy. No diagnosis for the lameness was obtained in three dogs. Findings supported FDG PET-CT as a useful adjunct imaging modality for detection of certain soft tissue injuries of the musculoskeletal system. Combined FDG PET-CT should be considered for cases where the cause of lameness is thought to be of soft tissue origin and cannot be diagnosed by conventional means. K E Y W O R D S functional imaging, myopathy, PET tracer, SUVmax, tendinopathy
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