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Background: Intermittent claudication can be neurogenic or vascular. Physicians use a profile based on symptom attributes to differentiate the 2 types of claudication, and this guides their investigations for diagnosis of the underlying pathology. We evaluated the validity of these symptom attributes in differentiating neurogenic from vascular claudication. Methods:Patients with a diagnosis of lumbar spinal stenosis (LSS) or peripheral vascular disease (PVD) who reported claudication answered 14 questions characterizing their symptoms. We determined the sensitivity, specificity and positive and negative likelihood ratios (PLR and NLR) for neurogenic and vascular claudication for each symptom attribute. Results:We studied 53 patients. The most sensitive symptom attribute to rule out LSS was the absence of "triggering of pain with standing alone" (sensitivity 0.97, NLR 0.050). Pain alleviators and symptom location data showed a weak clinical significance for LSS and PVD. Constellation of symptoms yielded the strongest associations: patients with a positive shopping cart sign whose symptoms were located above the knees, triggered with standing alone and relieved with sitting had a strong likelihood of neurogenic claudication (PLR 13). Patients with symptoms in the calf that were relieved with standing alone had a strong likelihood of vascular claudication (PLR 20.0). Conclusion:The classic symptom attributes used to differentiate neurogenic from vascular claudication are at best weakly valid independently. However, certain constellation of symptoms are much more indicative of etiology. These results can guide general practitioners in their evaluation of and investigation for claudication.Contexte : La claudication intermittente peut avoir une étiologie neurogène ou vasculaire. Les médecins utilisent un profil fondé sur les particularités des symptômes pour distinguer l'une de l'autre et ceci oriente leur choix des méthodes de diagnostic de la pathologie sous-jacente. Nous avons évalué la validité de ces particularités des symptômes utilisées pour distinguer la claudication d'origine neurogène de la claudication d'origine vasculaire. Méthodes :Des patients atteints d'une sténose spinale lombaire (SSL) ou d'une maladie vasculaire périphérique (MVP) avérées qui se plaignaient de claudication ont répondu à 14 questions afin de caractériser leurs symptômes. Nous avons déterminé la sensibilité, la spécificité et les rapports de probabilité positifs et négatifs (RPP et RPN) à l'égard de la claudication neurogène ou vasculaire pour chacune des particularités des symptômes.Résultats : Notre étude a regroupé 53 patients. La particularité des symptômes dotée de la sensibilité la plus élevée pour ce qui est d'écarter le diagnostic de SSL a été l'absence de « déclenchement de la douleur à la simple station debout » (sensibilité 0,97; RPN 0,050). Les données sur ce qui soulageait la douleur et sur la localisation des symptômes ont eu une faible portée clinique en ce qui a trait à la SSL et à la MVP. La présence d'une constellati...

The results from this work provide further insight into the expected injury and associated instability present in a traumatic unilateral facet injury in the cervical spine.

Background: Cancer is considered a cause of type B hyperlactatemia in dogs. However, studies evaluating cancer as a cause of clinically relevant type B hyperlactatemia (42.5 mmol/L) are lacking. Cancer cells have a higher lactate production because of increased aerobic glycolysis, known as the ''Warburg effect.'' The mechanisms through which aerobic glycolysis occurs are not well elucidated, but neoplasia may cause type B hyperlactatemia via this process.Objectives: To determine if malignant tumors of dogs are associated with clinically relevant type B hyperlactatemia (42.5 mmol/L).Animals: Thirty-seven client-owned dogs with malignant tumors: 22 with hematopoietic and 15 with solid tumors. Methods: Histology was used to confirm the diagnosis (cytology was considered adequate for diagnosis of lymphoma). Confounding conditions associated with hyperlactatemia were excluded. Lactate measurements were immediately performed on free-flow jugular whole blood samples using the LactatePro analyzer.Results: All dogs had lactate concentrations o2.5 mmol/L. Mean blood lactate concentration was 1.09 mmol/L. Mean blood lactate concentrations for solid and hematopoietic tumors were 0.95 and 1.19 mmol/L, respectively. Dogs with lymphoma (n 5 18) had a mean blood lactate concentration of 1.15 mmol/L.Conclusions: Malignant tumors were not considered a cause of clinically relevant type B hyperlactatemia. Therefore, cancer-related type B hyperlactatemia in dogs is uncommon, and hyperlactatemia should prompt careful investigation for causes other than cancer.

Purpose of the study: Osteonecrosis of the hip mostly affects young individuals and oftenprogresses to a debilitating disease. Several treatment modalities exist, but none are completely satisfactory. This study evaluates the clinical outcome of patients treated with core decompression and insertion of a porous tantalum implant in the femoral head. This procedure is similar to commonly performed procedures, but has the additional advantages of providing structural support to the necrotic femoral head while having no donor-site morbidity. Methods: We evaluated 15 patients with 18 osteonecrotic hips with Steinberg stage III (3 hips) and IV (15 hips) disease. The mean age of the patients was 42 years-old (eldest 66), and the mean time for follow-up was 23 months. The outcome measure was hip function, evaluated with the Harris hip score, and the end point was total hip arthroplasty, or referral for this procedure. Results: The success rate at twelve months postoperatively was 77.8%, and the overall success rate was 44.5%. Failures occurred at a mean time of 11.7 months, and one complication, a periprosthetic fracture, occurred 4 months postoperatively. On average, patients who did well improved their Harris hip scores by 21.7 points, and patients who eventually required arthroplasty decreased their scores by 14 points. Conlusions: Core decompression with porous tantalum implants showed encouraging success rates and early clinical results in patients with advanced stage osteonecrosis, but further larger scale studies are required to identify the population best suited for this procedure.