The laboratory as an aid to clinical diagnosis

The clinician may use the clinical pathology laboratory as a valuable aid to diagnosis and management, for the assessment of response to treatment, and in preventive medicine programs. Each "link in the chain," that is, sample selection, collection, handling, analysis, result reporting, and interpretation must be carefully and efficiently managed, using an informed combination of art and science, to provide a useful endpoint. This general introduction precedes more specific and detailed articles.     

Phalangeal bone ash as an aid in diagnosing some nutritional causes of lameness in sheep

Normal bone ash levels were determined on first phalangeal bones from lambs dying of acute causes and from abattoir specimens. First phalanges were chosen because they represent a whole bone thereby ensuring constant and natural proportion which would be difficult if sampling only a portion of a bone. No practical difference in percentage ash, expressed in terms of green bone weight, was found between fore or hind feet of young male or female sheep. Consequently a single regression equation can adequately express the relationship between bone ash and bone length for sheep up to about 9 months of age. Lambs suffering from hypocuprotic osteoporosis or osteodystrophy consistent with hypovitaminosis D have phalangeal bone ash values which tend to lie outside the lower range expected for normal sheep with first phalanges of similar length. Consequently bone ash can be a useful aid in the diagnosis of certain nutritional causes of lameness in sheep.     

Comparison of an inertial sensor system of lameness quantification with subjective lameness evaluation

Reasons for performing study: Subjective evaluation of mild lameness has been shown to have poor interobserver reliability. Traditional methods of objective lameness evaluation require specialised conditions and equipment. Wireless inertial sensor systems have been developed to allow for simple, rapid, objective lameness detection in horses trotted over ground. Objective: The purpose of this study was to compare the sensitivities of an inertial sensor system and subjective evaluation performed by experienced equine practitioners at detecting lameness in horses. We hypothesised that the inertial sensor system would identify lameness at a lower level of sole pressure than a consensus of 3 experienced equine veterinarians. Methods: Fifteen horses were fitted with special shoes that allowed for lameness induction via sole pressure. Horses were simultaneously evaluated by 3 equine veterinarians and a wireless inertial sensor system. Horses were subjected to multiple trials: 1) before inserting the screw; 2) after inserting the screw to just touch the sole; and 3) after tightening the screw in half turn increments. The number of screw turns required for lameness identification in the correct limb by the inertial sensors and by consensus of 3 equine veterinarians was compared using the Wilcoxon test. Results: The inertial sensor system selected the limb with the induced lameness after fewer screw turns than did the 3 veterinarians (P<0.0001). The inertial sensor system selected the correct limb before the 3 veterinarians in 35 trials (58.33%), the evaluators selected the correct limb before the inertial sensors in 5 trials (8.33%), and in 20 trials (33.33%) they selected the correct limb at the same time. Potential relevance: The inertial sensor system was able to identify lameness at a lower level of sole pressure than the consensus of 3 equine veterinarians. The inertial sensor system may be an effective aid to lameness localisation in clinical cases.     

Barium swallow as an aid to the diagnosis of grass sickness

Twenty-five horses, suspected on clinical grounds of having grass sickness, were given a barium swallow. Using image intensification the passage of the barium bolus was followed radiographically from the pharynx to the stomach. All 18 horses in which grass sickness was later confirmed at post mortem examination showed defective oesophageal motility. Although the specificity of the abnormality could not be proven, the technique offers a valuable aid to the ante mortem diagnosis of grass sickness.     

The role of scintigraphy in the lameness evaluation

Bone scanning to help diagnose orthopedic disease has been used in human patients for over two decades. The value of this diagnostic tool has been well established in helping to identify a variety of musculoskeletal conditions. It has only recently been used by veterinarians for more accurate characterization of equine musculoskeletal disease. The technique offers the major advantage of increased sensitivity over standard radiographic imaging. The case material illustrated here shows that except for consistent identification of bone cysts, most of the pathologic changes to the horse's musculoskeletal system that might cause lameness are detected on bone scans. Many acute bone diseases can be diagnosed by scintigraphy that cannot be discerned by radiographs until the condition has become chronic: Because of their body size, these conditions may not be diagnosed at all in horses. Scintigraphy in horses offers the other major advantage of affording accurate imaging of the upper limbs, pelvis, and vertebral column without general anesthesia. Therefore, it has a final advantage of increased safety over conventional radiography because it eliminates the need to perform general anesthesia to study these areas. In the author's experience, if abnormal uptake of isotope in the upper limbs, pelvis or spine is not observed, general anesthesia to radiograph those areas is not warranted. A second major benefit of scintigraphic imaging is to differentiate mixed lameness conditions in which the component of bone disease must be separated from that of soft tissues to arrive at a rational course of treatment or prognosis. Finally, for athletic horses suspected of having lameness due to localized myositis, scintigraphy not only allows confirmation of muscle inflammation but also identifies the muscle bellies injured reasonably accurately so that specific local treatment may be given. Nuclear imaging of equine skeletal disease is an option that should be employed more frequently by equine practitioners for diagnosis of difficult lameness cases. The technique is safe and comparatively inexpensive when one considers the total expense of multiple examinations or radiographic surveys of patients without conclusively diagnosing the source or sources of skeletal pain. This is particularly true when a horse owner becomes dissatisfied and enlists the services of one or more other veterinarians. The equine specialist will maintain better client rapport if he or she suggests referral of the horse to a veterinary medical teaching center or private clinic where scintigraphic imaging can be done rather than having the client become frustrated and seek another opinion elsewhere.(ABSTRACT TRUNCATED AT 400 WORDS)     

Serology as an aid to diagnosis: uses and abuses

The importance of correct interpretation of serological test results, common sources of error and problems associated with tests are discussed. In bovine brucellosis, a disease which is ideally suited to serological diagnosis, foetal contact with infection may cause the calf to be a serologically negative carrier. The immune tolerant animal resulting from foetal contact with virus is a major problem in the serological detection of border disease. In Johnes' disease and to a lesser extent in Brucella ovis and leptospiral infections, problems associated with sensitivity and specificity of the tests are stressed. Serovar specificity, cumbersome test procedures and negative tests in the incubation period cause difficulty in the interpretation of serological test results for leptospirosis. The importance of clinical examination, herd histories and alternative diagnostic procedures is important in all diseases. Wherever possible, flocks or herds should be maintained in specific disease-free state. Selection of stock from accredited herds or flocks is the most certain method of buying non-infected animals.     

Microfocal radiography as an aid to the diagnosis of canine elbow osteochondrosis

One normal cadaver specimen and six labrador retrievers with suspected elbow osteochondrosis were examined using a microfocal radiographic technique as an aid to diagnosis. This allowed the production of a magnified image (macro-radiograph) with high spatial resolution. The macroradiographs were compared with radiographs obtained using a standard technique to see if they facilitated decision making with respect to case management. The lesions that were suspected from radiographic examination were correlated with the gross lesions found at elbow arthrotomy. Microfocal radiography gave additional information about the changes within the joints but it still remained difficult to image the lesion satisfactorily in some cases.     

Serology as an aid to diagnosis: uses and abuses

The importance of correct interpretation of serological test results, common sources of error and problems associated with tests are discussed. In bovine brucellosis, a disease which is ideally suited to serological diagnosis, foetal contact with infection may cause the calf to be a serologically negative carrier. The immune tolerant animal resulting from foetal contact with virus is a major problem in the serological detection of border disease. In Johnes' disease and to a lesser extent in Brucella ovis and leptospiral infections, problems associated with sensitivity and specificity of the tests are stressed. Serovar specificity, cumbersome test procedures and negative tests in the incubation period cause difficulty in the interpretation of serological test results for leptospirosis. The importance of clinical examination, herd histories and alternative diagnostic procedures is important in all diseases. Wherever possible, flocks or herds should be maintained in specific disease-free state. Selection of stock from accredited herds or flocks is the most certain method of Guying non-infected animals.     

Development of an approach to lameness examination in cattle

In the preceding pages, the various components of an examination have been described. Each clinician will formulate his own method of utilizing these components. The following are suggested steps in a practical approach to the diagnosis of lameness. Evaluate the conditions under which restraint of the animal is possible (corral, free stall, stanchion barn). Assess the temperament, physical strength, and general amenability of the animal to be examined. If the animal is at liberty, its movements can be studied. If it is standing quietly observe it. If the animal is tied up and it seems feasible to examine the animal while it is walking, observe the animal and take its history while it is still tied up. Aggressive and wild animals should be observed, but little beneficial information will be gained from a regional approach to evaluating movement at this stage. Even if the seat of lameness seems to be in the proximal limb, it is mandatory in every case to examine the hooves and interdigital space at some stage during the evaluation. However, if the probability of proximal lameness is high, the clinician may proceed to make a complete evaluation, which would include studying the quality of movement before checking that the distal extremity is normal in every way. If the clinician decides to proceed with an examination of the digital region and is unable to locate a causative lesion in the extremity, he would then evaluate movement and manipulate and palpate the proximal limb. If no cause of the lameness becomes apparent, the nerve supply to the extremity would then be blocked.(ABSTRACT TRUNCATED AT 250 WORDS)     

Use of the Accusport semi-automated analyser to determine blood lactate as an aid in the clinical assessment of horses with colic

The most useful diagnostic methods in the initial evaluation of horses with colic assess the morphological and functional status of the gastrointestinal tract and cardiovascular status. This evaluation is best achieved using a combination of clinical and laboratory data. Blood lactate concentration (BL) is one of these variables. BL rises mainly due to poor tissue perfusion and anaerobic glycolysis associated with shock, providing an indicator of both the severity of disease and its prognosis. A hand-held lactate meter, Accusport, provides a rapid (60 seconds), inexpensive dry-chemical-based determination of BL. This trial evaluated the Accusport's ability to provide BL data as an adjunct to the initial clinical evaluation of horses with colic. The accuracy of the Accusport was tested by evaluation of its interchangeability with the benchmark enzymatic kit evaluation of BL in a trial using data collected firstly from 10 clinically normal control horses and subsequently from 48 horses presented with signs of colic. The BL values were recorded together with the clinical variables of heart rate (HR), capillary refill time (CRT), haematocrit (Hct), and pain character and severity on the initial assessment of the colic horses. Information regarding choice of therapeutic management (medical or surgical) and eventual case outcome (full recovery or died/euthanased) was recorded. The Accusport was found to be interchangeable with the enzymatic kit for recording BL values in colic horses with BL < 10 mmol/l, which is within the BL range associated with survival. The interchangeability of an additional, laboratory-based wet chemical assay for BL, the Stat 7 was simultaneously evaluated for the colic and control horses. The Stat 7 was found to be interchangeable with the enzymatic kit for BL determination of colic horses. No linear associations between BL values with HR, CRT, Hct or pain assessment were observed. No relationship with either selection of therapeutic method or eventual case outcome was observed. All horses with BL >8 mmol/l died or were euthanased.