Correct Therapy Research Articles

Initial antibiotic therapy for postoperative moderate or severe diabetic foot infections: Broad versus narrow spectrum, empirical versus targeted.

To retrospectively evaluate clinical and microbiological outcomes after combined surgical and medical therapy for diabetic foot infections (DFIs), stratifying between the empirical versus the targeted nature, and between an empirical broad versus a narrow-spectrum, antibiotic therapy. We retrospectively assessed the rate of ultimate therapeutic failures for each of three types of initial postoperative antibiotic therapy: adequate empirical therapy; culture-guided therapy; and empirical inadequate therapy with a switch to targeted treatment based on available microbiological results. We included data from 332 patients who underwent 716 DFI episodes of surgical debridement, including partial amputations. Clinical failure occurred in 40 of 194 (20.6%) episodes where adequate empirical therapy was given, in 77 of 291 (26.5%) episodes using culture-guided (and correct) therapy from the start, and in 73 of 231 (31.6%) episodes with switching from empirical inadequate therapy to culture-targeted therapy. Equally, a broad-spectrum antibiotic choice could not alter this failure risk. Group comparisons, Kaplan-Meier curves and Cox regression analyses failed to show either statistical superiority or inferiority of any of the initial antibiotic strategies. In this study, the microbiological adequacy of the initial antibiotic regimen after (surgical) debridement for DFI did not alter therapeutic outcomes. We recommend that clinicians follow the stewardship approach of avoiding antibiotic de-escalation and start with a narrow-spectrum regimen based on the local epidemiology.

RESULTS OF IMMUNE STATUS IN SICK CHILDREN WITH NEURODERMITIS USING ACUNE REFLEX THERAPY AND EXTERNAL THERAPY

Increasing the effectiveness of the treatment of dermatological patients with neurodermitis is an important social task. This is due to the significant spread of a number of dermatoses and the severe course of some of them. The traditional methods of treatment currently used in dermatology are far from always effective, and sometimes they themselves are associated with a variety of side effects and complications, sometimes very severe. In this regard, the great interest that is manifested in non-drug methods of therapy is understandable. One of these methods is acupuncture. Purpose of the study. To study immunological indicators in children with neurodermitis and develop a method of corrective therapy in the process of acupuncture with the use of broncho-munal. Materials and research methods. 32 children with neurodermitis aged 12 to 14 years were under observation. The results of the studies allow us to conclude that acupuncture has a normalizing effect on the parameters of the humoral link of the immune system of girls with neurodermitis. The question arises about the possible mechanisms of such action of acupuncture. In addition to the well-known general effects of acupuncture on the human body in the form of stimulation of the function of the adrenal cortex, the central nervous system, a decrease in the level of certain biologically active substances, the possibility of a direct effect of acupuncture on some lymphoid organs through the acupuncture points responsible for them is not excluded. Conclusions: In the pathogenesis of sick children with neurodermitis, there is a change in the functional activity of the humoral link of immunity, expressed in an increase in the level of serum IgE. Acupuncture, being an effective method of treating girls with neurodermitis, has a normalizing effect on some of the altered parameters of the humoral immunity in children with neurodermitis. expressed in an increase in the level of serum IgE. Acupuncture, being an effective method of treating girls with neurodermitis, has a normalizing effect on some of the altered parameters of the humoral immunity in children with neurodermitis. expressed in an increase in the level of serum IgE. Acupuncture, being an effective method of treating girls with neurodermitis, has a normalizing effect on some of the altered parameters of the humoral immunity in children with neurodermitis.

Contour integration deficits at high spatial frequencies in children treated for anisometropic amblyopia.

This study was conducted to reexamine the question of whether children treated for anisometropic amblyopia have contour integration deficits. To do so, we used psychophysical methods that require global contour processing while minimizing the influence of low-level deficits: visibility, shape perception, and positional uncertainty. Thirteen children with anisometropic amblyopia (age: 10.1 ± 1.8 years) and thirteen visually normal children (age: 10.8 ± 2.0 years) participated in this study. The stimuli were closed figures made up of Gabor patches either in noise or on a blank field. The contrast thresholds to detect a circular contour on a blank field, as well as the thresholds of aspect ratio and contour element number to discriminate a circular or elliptical contour in noise, were measured at Gabor spatial frequencies of 1.5, 3, and 6 cpd for amblyopic eyes (AEs), fellow eyes (FEs), and normal control eyes. Visual acuities and contrast sensitivity functions for AEs and FEs and the Randot stereoacuity were measured before testing. The AEs showed contrast deficits and degraded shape perception compared to the FEs at higher spatial frequencies (6 cpd). When the influence of abnormal contrast sensitivity and shape perception were minimized, the AEs showed contour integration deficits at spatial frequencies 3 and 6 cpd. These deficits were not related to basic losses in contrast sensitivity and acuity, stereoacuity, and visual crowding. Besides, no significant difference was found between the fellow eyes of the amblyopic children and the normal control eyes in the performance of contour integration. After eliminating or compensating for the low-level deficits, children treated for anisometropic amblyopia still show contour integration deficits, primarily at higher spatial frequencies, which might reflect the deficits in global processing caused by amblyopia. Contour integration deficits are likely independent of spatial vision deficits. Refractive correction and/or occlusion therapies may not be sufficient to fully restore contour integration deficits, which indicates the need for the development of clinical treatments to recover these deficits.

Intravenous iron and erythropoietin therapy for postoperative anemia among orthopedic surgery patients

BackgroundPostoperative anemia is a risk factor for adverse surgical outcomes. Our study aimed to assess the role of intravenous iron and erythropoietin therapy for the rapid correction of anemia following orthopedic surgery.MethodsPatients undergoing elective orthopedic surgery were prospectively enrolled and randomly divided into three groups: Control (placebo), Group 1 (IV iron monotherapy), and Group 2 [combined IV iron and recombinant human erythropoietin (rHuEPO) therapy]. Blood tests were performed preoperative (baseline) and on postoperative days (PODs) 1, 3, and 7.ResultsAll groups demonstrated significantly lower hemoglobin (Hb) concentrations compared to baseline, with no significant inter-group differences in postoperative Hb concentrations (p > 0.05). Serum erythropoietin, ferritin, and vitamin B12 levels, and reticulocyte count increased beyond normal ranges in all groups. Significantly lower serum iron levels were observed postoperatively in all groups (p < 0.05). No significant inter-group differences in hepcidin level were observed (p > 0.05).ConclusionPostoperative treatment with combined intravenous iron and rHuEPO was ineffective in correcting postoperative anemia among orthopedic surgery patients, besides achieving higher reticulocyte counts in the first week of surgery. No improvement in mobilization of storage iron was achieved with rHuEPO. We further suggest against vitamin B12 administration during the early postoperative period.

Antimicrobial stewardship program in urinary tract infections due to multiresistant strains in the emergency department

Urinary tract infections (UTI) are a frequent reason for attendance at emergency department (ED). The present study evaluates the impact of a multidisciplinary program for the optimization of antibiotic therapy in patients with UTI caused by multi-drug resistant bacteria treated from the hospital ED. Descriptive study of the implementation of a program in which emergency, microbiology and pharmacy departments participated. Antibiotic treatment of the patients who consulted the ED with positive urine cultures caused by multidrug-resistant bacteria was reviewed upon discharge. In those patients with inappropriate treatment, doctors and/or pharmacists of the next level of healthcare or patients in the case of home discharge were contacted. The impact of the program was evaluated based on new visits to the ED at 30 days after discharge, compared with the results obtained from the usual practice three months prior the intervention. During the first year, 2,474 urine cultures of patients with UTI were reviewed, 533 (21.7%) were caused by multidrug-resistant bacteria. Empirical treatment was inappropriate in 287 (53.4%), making treatment modifications in 243 of them. 73 (19.3%) patients returned to the ED 30 days after discharge, being lower than the results obtained in the three months prior intervention (27.9%; p=0.031), without significant differences in new visits associated with UTI. The implementation of a multidisciplinary program focused on multidrug resistant UTI at discharge form ED correct antibiotic therapy in a large number of patients, being a potentially tool to reduce the number of new ED visits.

Phospholipid composition of bile and blood in rats under correction of experimental fatty hepatosis

To date, the aetiology and molecular mechanisms of the development of fatty hepatosis, which is quite common in mammals, have not yet been sufficiently explained. This pathology requires detailed study not only because of functional disorders of the liver and biliary system, but also because of the high probability of dangerous complications – fibrosis, cirrhosis, or hepatocellular carcinoma. The purpose of this study was to determine marker changes in the phospholipid composition of bile and blood in rats with experimental fatty hepatosis and with the use of corrective therapy. Hepatopathology was modelled in Wistar laboratory rats by intragastric administration of a 4% solution of tetracycline hydrochloride at the rate of 0.25 g/kg body weight for seven days. Using the method of thin-layer chromatography, the phospholipid components of animal bile and blood were studied. It was found that during experimental fatty hepatosis in rats, there was a decrease in the total phospholipid content in bile, mainly due to a decrease in the level of phosphatidylcholine (by 22.4-27.0%), the total fraction of inositol phosphatide and phosphatidylinositol (by 20.0-27.3%), and phosphatidylethanolamine (by 17.5-25.2%). Conversely, the introduction of milk phospholipids in the form of a dietary supplement “FLP-MD” in sick animals contributed to an increase in bile levels of phosphatidylserine by 67.1-99.8%, inositol phosphatide and phosphatidylinositol by 48.6-57.6%, phosphatidylcholine by 38.8-60.2%, phosphatidylethanolamine by 45.6-57.4%, and sphingomyelin by 30.4-46.3%. In the blood of such rats, a significant decrease in the content of phosphatidylcholine, phosphatidylserine, and sphingomyelin was found, which was not observed after administration of the “FLP-MD” dietary supplement to sick animals. In the case of using the supplement in healthy animals, only a 29.3% increase in the blood content of inositol phosphatide and phosphatidylinositol was noted. The determination of the most sensitive indicators in the phospholipid spectrum of blood and bile reveals the features of changes in molecular processes for the development of fatty hepatosis in animals, and also contributes to preclinical tests of the corrective effectiveness of newly created drugs according to established markers

Temporomandibular joint dysfunction syndrome – a therapeutic approach

1) Background: Temporomandibular joint (TMJ) is responsible for vital functions like mastication, swallowing, and suction reflex and other relational functions, like talking and phonation. The etiology of temporomandibular joint disorders is multifactorial and involves subjective and objective clinical symptomatology. (2) Methods: The therapy is complex and encompasses a series of methods that interconnects various medical spe-cialties. Bad habits and parafunction are risk factors that may initiate and exacerbate a temporomandibular joint pathology. This prospective study aimed to show the positive impact of correct multidisciplinary therapy on the complex of TMJ disorders - pain and bad oral behaviors. The therapy methods used in this study were: medical, prosthetic, or-thodontic, surgical, and physiotherapy (PKT). (3) Results: The data obtained showed good results if the oral habits and TMJ disorders are treated correctly and simultaneous-ly. (4) Conclusions: All therapeutical approaches addressed in this study had beneficial effects on the recovery of the temporomandibular joint. Keywords: therapeutic approach; temporomandibular joint; TMJ disorders; pain; multidisci-plinary therapy

Temporomandibular joint dysfunction syndrome – a therapeutic approach

Background: Temporomandibular joint (TMJ) is responsible for vital functions like mas-tication, swallowing, and suction reflex and other relational functions, like talking and phonation. The etiology of temporomandibular joint disorders is multifactorial and in-volves subjective and objective clinical symptomatology. (2) Methods: The therapy is complex and encompasses a series of methods that interconnects various medical spe-cialties. Bad habits and parafunction are risk factors that may initiate and exacerbate a temporomandibular joint pathology. This prospective study aimed to show the positive impact of correct multidisciplinary therapy on the complex of TMJ disorders - pain and bad oral behaviors. The therapy methods used in this study were: medical, prosthetic, or-thodontic, surgical, and physiotherapy (PKT). (3) Results: The data obtained showed good results if the oral habits and TMJ disorders are treated correctly and simultaneous-ly. (4) Conclusions: All therapeutical approaches addressed in this study had beneficial effects on the recovery of the temporomandibular joint.

Understanding Dissociative Identity Disorder: A Literature Review

Interest in dissociative identity disorder (DID) in psychiatry has increased rapidly although epidemiologically the cases of patients with DID are still rare, several studies exist trying to understand how DID might occur and the best therapeutic approach. Some of the symptoms of DID can also be found in non-clinical populations even though they are not directly related to the disorder. The findings of DID are often associated with other psychiatric disorders and can complicate the diagnosis. Various studies have tried to understand the case of DID either objectively or subjectively. Diagnosis of DID must be diagnosed by carefully experienced clinicians with clinical interviews with some proper tests that could help to identify various identities. Current DID therapy may be able to strengthen the identity of the patient’s control and prevent impaired social functioning of the patient. Many pharmacological and non-pharmacological treatments have been developed to improve symptoms of the disorder, but none of them have been effective due to the quality of the studies conducted. Further research is still needed on DID as a whole to assist in the correct diagnosis and therapy for DID patients.

Magnetic sphincter augmentation: paradigm change or just another device in the surgeon's toolbox?

The common denominator for virtually all episodes of gastroesophageal reflux in health and disease is the loss of the barrier that confines the distal esophagus to the stomach. Factors important in maintaining the function of the barrier are its pressure, length and position. In early reflux disease, overeating, gastric distention and delayed gastric emptying led to a transient loss of the barrier. A permanent loss of the barrier occurs from inflammatory injury to the muscle allowing free flow of gastric juice into the esophageal body. Corrective therapy requires augmentation or restoration of the barrier referred to more commonly as the lower esophageal sphincter.

#3390 ADPKD PREDICTOR: A CLOUD-BASED PROGNOSTIC TOOL FOR AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

Abstract Background and Aims ADPKD is a progressively debilitating genetic disease characterized by the growth of numerous cysts in the kidneys, leading eventually to end-stage renal disease. Total Kidney Volume (TKV) is accepted by FDA and EMA as a prognostic biomarker and quantitative predictor of kidney function decline, and is currently used to select patients to receive Tolvaptan treatment. However, TKV calculation from manual tracing of medical images is labor-intensive; for better accuracy, current available methods involve the injection of an iodinated contrast medium for CT scan, with important limitations in patients with impaired renal function. We developed ADPKD Predictor, a user-friendly cloud-based tool for fast and accurate estimation of disease classification and progression, based on automated kidney and cysts segmentation from MRI data. Method An online tool was designed on Microsoft Azure Cloud to automatize the set-up and running of a previously developed algorithm implemented in MATLAB to automatically detect kidneys and cysts contours from MRI data (T2-weighted turbo-spin-echo SPIR), based on advanced image processing techniques [1]. Through the web interface, the user is requested to upload the MRI data and select one point inside kidney's parenchyma in the central slice (Figure 1). Then, TKV is automatically calculated and eGFR based on CKD-EPI equation, ADPKD Imaging Classification and future eGFR [2], estimated Tolvaptan treatment effect [3], and GFR Category based on KDIGO CKD staging system are obtained (Figure 2). The MRI dataset is anonymized before upload to the cloud; data and results are stored in a secure and reliable environment controlled by the user. Results The proposed solution is very fast and precise compared to manual segmentation of medical images (absolute mean error 2.4% ± 2.7%) [1]. Moreover, it is faster and more accurate than the commonly used ellipsoid-based method, resulting in a manifold reduction of misclassification error (2.5%) [1] and therefore potential therapeutic consequences. Another advantage is its usability, with no specific computational expertise, numerical software or dedicated hardware required, since all computations are run remotely in the cloud. Conclusion ADPKD Predictor provides a fast and reproducible assessment of risk classification and disease progression, based on precise morphologic classification of the renal and cysts volume of patient. The proposed solution represents an extremely useful tool for researchers and clinicians to easily obtain an accurate estimation of risk classification potentially helping in a correct and effective stratification of patients, and monitor patient's disease progression, hence supporting a correct and effective therapy administration. Also, it would represent a great benefit for the patient, since the tool analyzes medical images obtained without the use of contrast medium.

#5471 THE URINARY BIOMARKERS IGFBP7 AND IGFBP7 X TIMP2 PRE-EMPTIVELY IDENTIFY PATIENTS AT RISK OF CONTRAST NEPHROTOXICITY

Abstract Background and Aims Drug nephrotoxicity is a serious medical and economic concern. In fact, 25% of the 100 most used drugs in intensive care units are toxic to the kidney, which limits their use and, therefore, the correct therapy for the patient. The administration of contrast media (CM) during diagnostic tests or surgical interventions carries the risk of contrast-induced nephropathy (CIN), which is a clinical condition defined as an increase in plasma creatinine of 25% or 0.5 mg/dL above baseline within 3-5 days after administration. Because once installed CIN has no treatment, identification of new biomarkers predicting patients at risk of CIN before receiving CM may be crucial to prevent future kidney complications. Clinical studies conducted in other medical areas have identified new urinary biomarkers, such as insulin like growth factor binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinases 2 (TIMP2), that anticipate the risk of developing kidney damage after the administration of different potentially nephrotoxic compounds. The objective of this work was to evaluate the usefulness of these biomarkers to predict CIN in cardiac patients. Method A clinical study was carried out with 154 patients from the University Hospital of Salamanca Cardiology Department who subsequently received a CM. Prior to contrast administration, urine samples were collected. In addition, their plasma creatinine level was registered for the following 5 days to evaluate the development of CIN. Patients were divided into Controls (who did not develop CIN) and Cases (who developed CIN). IGFBP7 and TIMP2 biomarkers were quantified in urine samples by ELISA. Subsequently, the differences between both groups were evaluated using the Mann-Whitney U test and the diagnostic capacity of each biomarker was analyzed through the generation of its receiver operating characteristic (ROC) curve. Results Of the total number of patients, 123 were assigned to the Controls group and 31 to the Cases group. In both groups the distribution of sex and risk factors was similar, except for the case of age and body mass index, which was slightly lower and higher, respectively, in the Controls group. IGFBP7 was significantly higher in Cases (p &amp;lt; 0.01) compared to the Controls, and the IGFBP7 x TIMP2 product further improved this significance (p &amp;lt; 0.001). Specifically, the area under the ROC curve for IGFBP7 was 0.67 (95% confidence interval of 0.56-0.78); while that for IGFBP7 x TIMP2 increased to 0.73 (with a 95% confidence interval of 0.63-0.84). In contrast, TIMP2 alone showed no differences between both groups of patients. Conclusion The biomarkers IGFBP7 and IGFBP7 x TIMP2 could therefore be used for the prophylactic identification and management of patients at risk of developing CIN.

WED-357 - The role of prolonged albumin replacement therapy in correction of its structure and functional properties and management of ascites

WED-357 - The role of prolonged albumin replacement therapy in correction of its structure and functional properties and management of ascites

Case Report: A rare case of CD20-positive T-cell large granular lymphocyte leukemia with renal cell carcinoma: a challenging diagnosis

Large granular lymphocytic leukemia (LGLL) is a clonal lymphoproliferative disease with a slow course and considerable difficulties in correct diagnosis and therapy. T-LGLL is the most prevalent subtype of LGLL, accounting for approximately 85%. T-LGLL co-existence with solid malignancies is relatively rare. CD20-positive T-cell neoplasm is a rare disease in clinics. In this study, we report a case of CD20-positive T-LGLL with renal cell carcinoma (RCC) that was eventually diagnosed by splenectomy and nephrectomy. The accumulation of cases will contribute to diagnosing and treating CD20-positive T-LGLL complicated with solid tumors.

A clinical case of the use of a combination of cimicoxib and cyclophosphamide in metronomic mode in neoadjuvant therapy of complex breast carcinoma of a dog

The results of the use of a combination of cimicoxib and cyclophosphamide, in metronomic mode, in neoadjuvant therapy of complex breast carcinoma in dogs are presented. This treatment regimen allowed to achieve stabilization of the process, the volume of the tumor decreased by 60.77% of the indicators of the first day. The regression was 39.23%. According to the results of hematological blood examination, by the 90th day of therapy, the number of leukocytes decreased by 75.96%, lymphocytes by 79.67% and granulocytes by 75.64%, to reference values. The number of red blood cells and the level of hemoglobin increased by 49.57% and 53.98%, respectively. There was an increase in the amount of hematocrit by 52.35% compared to the values of the first day before therapy. Biochemical parameters of blood serum by the end of drug therapy were within the reference values. There were no signs of hematological and general toxicity, according to the WHO scale, requiring corrective therapy, dose reduction or withdrawal of drugs.

Specific xenon-based gas mixtures used for stress correction therapy in patients exposed to lethal force scenarios

Introduction. Stress reaction in deadly scenarios is a systemic response of human body to the impact of extreme and acute psychotraumatic factors. The condition is associated with complete or partial loss of ability to perform tasks and can lead to the development of post-traumatic stress disorder. Therefore, new effective means and methods of stress correction in lethal force scenarios is a most urgent challenge for catastrophe medicine.The objective is to estimate the therapeutic efficacy of xenon gas mixtures in the treatment of different categories of employees exposed to occupational hazards, including acute stress.Methodology. A randomized controlled experimental study was conducted, involving 48 employees of law enforcement bodies and rescue operations professionals. Acute stress disorders were treated using a course of oxygen-xenon gas mixture inhalations (oxygen – 75 %, xenon – 25 %). Comprehensive medical and psychological examination allowed to monitor treatment efficiency.Results and discussion. Oxygen-xenon gas mixture inhalations contributed to normalization of systemic hemodynamics, improved parasympathetic activity and reduced sympathetic nervous system activity, leading to a significant reduction in the level of anxiety and improvement of psychopathological symptoms.Conclusion. The obtained findings provide extra evidence showing that xenon-based gas mixtures are a promise as a stress correction tool in patients exposed to lethal force scenarios and acute occupational hazard.

The mental and maternal health of women in flood-affected areas in Pakistan: a call for action

The mental and maternal health of women in flood-affected areas in Pakistan: a call for action

Prognosis of the development of purulent-necrotic complications in stump of the hip

Purpose of the study : to develop of method for prediction of development of purulent-necrotic complications in amputation stump of the hip. Material and methods. 90 disease histories of patients of both sexes were analyzed, aged 40–91 years old (mean age 65 (40; 91)), admitted to the hospital with a diagnosis of obliterating atherosclerosis of the vessels of the lower extremities, critical ischemia or gangrene of the foot. Patients were divided into two clinical groups: 1st group - 69 (76.7%) patients with a favorable course of the postoperative period; and 2nd group – 21 patients (23.3%) with a complicated postoperative period of infection of the thigh stump wound. Results . The original method developed includes the determination of the following risk factors: the systemic nature of atherosclerotic vascular damage; amputation at the level of the upper third of the hip; emergency surgery; hematoma in the early postoperative period; prothrombin time; INR; a quick prothrombin test: when receiving the sum of points 16 and more, a high risk of development is predicted, with the sum of points from 13 to 15 – moderate risk; and with a score of less than 12 – low risk of developing purulent-necrotic complications in amputation stump of the hip. Conclusion . Proposed method allows to objectively and quickly determine development of purulent-necrotic complications in amputation stump of hip, which further allows to correct starting therapy and in cases of high risk of development of complications, to prescribe enhanced antibacterial and detoxification therapy.

Cystic fibrosis - Ways to improve the quality of life of patients

Introduction Cystic fibrosis (CF) is a serious, multi-system disease. In the Caucasian population CF is the most common autosomal recessive disease, which happens for 1 person in 3,500 births [1]. In the course of CF, there is a dysfunction of many organs, mainly the respiratory and digestive systems. Symptomatic treatment of cystic fibrosis is very important. The change in daily eating habits, the use of proper breathing techniques and psychotherapy also have an impact on improving the quality of life of patients. In the past patients died at a young age. The progress in the diagnosis and treatment of cystic fibrosis has meant that nowadays more and more people are reaching adulthood. In recent years, the median survival of patients has increased to 46.2 years. [2] Purpose The aim of this review is to present the current state of knowledge about ways to improve the quality and length of life of patients with CF. Methods The literature available in the Pubmed and Google Scholarship databases was reviewed using key phrases. Results Additional methods of treatment, such as: learning the correct breathing technique, oxygen therapy, physical exercise or proper nutrition, significantly improve the living conditions of patients.

Comparative evaluation of radiographic and computed tomographic findings in dogs with bilateral medial coronoid disease (MCD) presenting with unilateral forelimb lameness.

The purpose of this study was to compare the radiographic and computed tomographic (CT) findings of dogs with diagnosed bilateral medial coronoid disease, which showed clinically only unilateral lameness of the forelimbs. Medical records, including radiographs and CT images of dogs with diagnosed bilateral MCD showing only a unilateral forelimb lameness clinically were reviewed retrospectively. Depending on the gait of each dog we established two groups to investigate their radiographs and CT data comparatively. Group I: affected non-lame limb. Group II: affected lame limb. Several evaluation systems were used to assess which factors are important for clinical decision making and a patient tailored therapeutic plan. Data from 84 affected elbow joints (42 dogs) diagnosed with MCD by computed tomography were included. Both the radiological and the CT analysis showed that there are significant differences between Groups I and II. Group I had a lower modified International Elbow Working Group Score (IEWG), the values of the Trochlear notch sclerosis were only slightly deviated, and this group showed less often a dislocation of the fragment compared to group II. Furthermore, the size of the fragment (both the median and the mean value) of the forelimbs from group II was almost twice as big as the one from group I. The following sizes of the fragments were calculated (group I versus (vs.) group II)-median: 0.09 cm2 vs. 0.16 cm2, mean value: 0.112 cm2 vs. 0.202 cm2. It could be shown that a larger fragment is more likely to dislocate than a smaller one. This study provides some evidence towards a better understanding of which diagnostic parameters and findings might be important in clinical decision making. Nevertheless, a "decision tree" for the correct therapy of MCD could not be determined in this study.