Endoscopic surgery in the treatment of contaminated and infected synovial cavities

REASONS FOR PERFORMING STUDY: Contamination and infection of synovial cavities are a common occurrence in clinical practice and, if inadequately treated, may have career or life threatening consequences for affected horses. HYPOTHESIS: The objectives in treating contamination and infection of joints, tendon sheaths and bursae are most effectively met by endoscopic surgery. METHODS: Over a 6 year period, cases of synovial contamination and infection admitted to a referral clinic were evaluated and treated endoscopically. The horses received local and systemic antimicrobial drugs with minimal nonsteroidal anti-inflammatory medication but no other medical or surgical treatment. All arthroscope and instrument portals and, whenever possible, all traumatic wounds were closed. Diagnostic information, endoscopic observations and results of treatment were evaluated retrospectively. RESULTS: A total of 140 affected animals were referred and 121 cases were treated endoscopically. These involved 70 joints, 29 tendon sheaths, 10 bursae and in 12 cases a combination of synovial cavities. The most common aetiologies were open wounds (n = 54) and self-sealing punctures (n = 41). Foreign material was identified endoscopically in 41 but predicted prior to surgery in only 6 cases. Osteochondral lesions were evident at surgery in 51 and recognised before surgery in 25 cases; 32 horses had intrathecal tendon or ligament defects. Follow-up information was obtained for 118 animals; 106 (90%) survived and 96 (81%) returned to their preoperative level of performance. The presence of osteitis/osteomyelitis, other osteochondral lesions and marked deposits of pannus were associated with nonsurvival. For those animals which survived, non-Thoroughbred horses, a combination of synovial structure involvement and regional i.v. antimicrobial administration were associated with reduced post operative performance. Marked pannus, regional i.v. antimicrobial administration and duration of systemic antimicrobial administration were associated with a group combining nonsurviving animals and those with reduced post operative performance. CONCLUSIONS: Endoscopic surgery makes a valuable contribution to the management of synovial contamination and infection. POTENTIAL RELEVANCE: The information obtained from and therapeutic options offered by endoscopy justify its early use in cases of synovial contamination and infection.     

Bilateral phacofragmentation in a New Zealand fur seal (Arctocephalus forsteri).

Ophthalmic examination under anesthesia of a 5-yr-old, captive, male New Zealand fur seal (Arctocephalus forsteri) with reduced visual capacity revealed bilateral cataracts. Surgical extraction of the lenses was performed by phacofragmentation. Preoperative mydriasis was unsuccessful using common topical mydriatic agents. Intraoperative intracameral epinephrine 1:10,000 produced minimal pupillary dilation, but excellent dilation was achieved with intracameral epinephrine at 1:1,000. Postoperative uveitis was controlled with oral prednisolone. Postoperative complications included generalized corneal edema persisting for approximately 1 wk and corneal ulceration caused by the lateral canthotomy sutures. Vision was restored in both eyes.     

Pitfalls in immunofluorescence testing in dermatology. III. Pemphigus-like antibodies in the horse and direct immunofluorescence testing in equine dermatophilosis

Indirect immunofluorescence testing for pemphigus-like antibodies was performed on 79 horses: 28 horses with various nonpemphigus dermatologic diseases, 21 horses with various nondermatologic diseases, and 30 normal horses. Pemphigus-like antibodies were detected in 6 horses: 3 normal horses with titers of 1:40, 2 horses with dermatophilosis at titers of 1:10 and 1:80, and 1 horse with lymphosarcoma at a titer of 1:320. It was concluded that equine pemphigus-like antibodies are a potential source of misinterpretation and misdiagnosis in indirect immunofluorescence testing. Direct immunofluorescence testing for whole immunoglobulin, IgG, IgM, and IgA was performed on skin lesions from 2 horses with dermatophilosis. Diffuse intercellular deposition of whole immunoglobulin and IgG was found in both horses. It was concluded that equine dermatophilosis is a potential source of misinterpretation and misdiagnosis in direct immunofluorescence testing.     

Reorganizing small animal gross anatomy: improving the faculty and student experience and incorporating non-technical competency development

The organization of the small animal gross anatomy course at Washington State University's College of Veterinary Medicine was modified in several ways over a two-year period. These modifications were motivated in part by the need to accommodate a larger number of students, but also by our desire to make more efficient use of faculty and student time as well as physical resources and to give our students opportunities to develop non-technical competencies such as communication and teamwork skills. The four major changes were (1) increasing dissection group size, (2) assigning specimens to dissection groups on a rotating basis, (3) reducing the amount of dissection time relative to time spent studying prepared specimens, and (4) introducing 'transition reviews,' a limited form of peer teaching meant to emphasize peer interaction and communication skills rather than conveyance of specific and detailed subject matter. This article describes the details of these changes and evaluates their effectiveness based on faculty assessments, results from surveys of participating students, and comparison of examination performance and formal end-of-course student evaluations before and after reorganization of the course. Increasing the dissection group size and reducing per-student dissection time did not adversely affect student performance and were viewed at least neutrally or favorably by most students. Notably, the rotation of specimens and the transition reviews elicited strongly favorable responses from a large majority of students and had several beneficial effects of which students may not have been aware but which were apparent to participating faculty. Overall, the changes were well received by both faculty and students and were, in our view, of sufficient value that this course organization plan would be used regardless of class size.     

Estimation of linkage disequilibrium in a sample of the United Kingdom dairy cattle population using unphased genotypes

The association between genetic marker alleles was estimated for two regions of the bovine genome from a random sample of 50 young dairy bulls born in the United Kingdom between 1988 and 1995. Microsatellite marker genotypes were obtained for six markers on chromosome 2 and seven markers on chromosome 6, spanning 38 and 20 cM, respectively. Two different methods, which do not require family information, were used to estimate population haplotype frequencies. Haplotype frequencies were estimated for pairs of loci using the expectation-maximization algorithm and for all linked loci using a Bayesian approach via a Markov chain-Monte Carlo algorithm. Significant (P = 0.0007) linkage disequilibrium was detected between pairs of loci in syntenic groups (that is, loci in the same linkage group), extending to about 10 cM. No significant linkage disequilibrium was detected between markers in nonsyntenic regions. Given the observed level of linkage disequilibrium, mapping methods based on population-wide association might provide a better resolution than traditional quantitative trait loci mapping methods in the U.K. dairy cattle population and may reduce the required sample sizes of the experiments.     

Letters to the editor

Extract

In order to utilize spring growth efficiently under a system of grassland farming, a New Zealand dairy farmer endeavours to calve as many cows as possible within a four to six weeks' period. To maintain this calving pattern, herd members must conceive by 70 to 80 days after calving. Consequently normal postparturient uterine involution, together with a minimum of delay in the onset of ovarian activity and oestral cyclicity, is of vital importance. A study of these phenomena may be very rewarding in helping to achieve optimal reproductive efficiency.     

Subacute atropine toxicity in a pygmy sperm whale, Kogia breviceps.

Atropine, an anticholinergic agent commonly used in human and veterinary medicine, is reported to cause toxicity associated with its antimuscarinic action. A juvenile pygmy sperm whale, Kogia breviceps, was treated with atropine in an attempt to relieve symptoms similar to pyloric stenosis, as has been used in humans. Two doses of 0.01 mg/kg were given i.m., 12 hr apart, followed by three doses of 0.005 mg/kg i.m. s.i.d. over the next 3 days. Symptoms associated with atropine toxicity developed gradually and included hyperexcitability, a generalized ascending paralysis of body musculature, shallow, rapid respiration, vomiting, aspiration of seawater, and pulmonary edema. Treatment with physostigmine salicylate (two doses of 2 mg i.m., I hr apart) was effective in counteracting the paralysis, as well as other symptoms, beginning in as little as 17 min after the first dose, and the whale was back to swimming on its own after 8 hr. All overt symptoms of atropine toxicity were gone in about 24 hr, but there were other possible sequella that lasted much longer.     

Periovulatory endocrinology and oocyte maturation in unmated mature blue fox vixens (Alopex lagopus)

Nine of 10 mature blue fox vixens (Alopex lagopus) in spontaneous oestrus ovulated approximately 2 days after the preovulatory increase in luteinizing hormone (LH). Plasma concentrations of follicle-stimulating hormone and progesterone increased simultaneously with the LH peak, whereas oestradiol-17 beta peaked 1 day previously. In the tenth vixen, an LH peak was not observed, and neither visible follicles nor corpora lutea were found in the ovaries 6 days after peak vaginal electrical resistance. Eggs were ovulated as primary oocytes, but oocyte maturation was initiated within the day of ovulation (2 days after the LH peak). Within the next 2 days (3-4 days after the LH peak) the first polar body was extruded, and the cumulus mass was completely dissociated from the zona pellucida. The interval between the preovulatory LH peak and initiation of the final oocyte maturation is thus considerably longer in the blue fox than for example in the cow (48-72 h compared with 9-12 h). This suggests that the relationship between these two events is somewhat different in the blue fox.     

Neurologic abnormalities as the predominant signs of neoplasia of the nasal cavity in dogs and cats: seven cases (1973-1986)

Neurologic abnormalities were the predominant historic and physical findings in 5 dogs and 2 cats with primary nasal cavity tumors that had invaded the cranial vault. Seizures, behavior changes, and obtundation were the most common signs. Other neurologic signs included paresis, ataxia, circling, visual deficit, and proprioceptive deficit. Although 1 dog and 2 cats had historic findings of mild respiratory disease, no physical abnormalities related to the respiratory tract were found in any of the 7 animals. Nasal cavity neoplasia was suggested by radiographic and computed tomographic studies and was confirmed histopathologically in each case. The nasal tumor types in the 5 dogs were epidermoid carcinoma (n = 1), adenocarcinoma (n = 2), solid carcinoma (n = 1), and anaplastic chondrosarcoma (n = 1). An esthesioneuroblastoma was found in each cat. Radiation therapy was effective for 3 months in palliating the clinical signs in the 2 dogs in which it was used. Neoplasia of the nasal cavity should be considered in the differential diagnosis for animals with neurologic signs suggestive of cerebral disorders.