Quality of equine veterinary care. Part 2: Client satisfaction in equine top sports medicine in The Netherlands

The aim of this study was to evaluate systematically the quality of equine veterinary top sports medicine in The Netherlands and the degree to which the expectations in the field are met. Focus was on structure, process and outcome of care. The structure of care is generally satisfactory but there is insufficient transfer of applicable scientific knowledge to the equine community and a lack of regular checks by team vets. The process of care is hampered by the failure in communication between the veterinary and paraveterinary members of a team. For continuation of the excellent international results of Dutch riders and drivers a more collaborative approach, abandoning the often secretive character of equine medicine in relation to sport horses, is necessary.     

The relationship between growth and osteochondrosis in specific joints in pigs

Osteochondrosis (OC) is a disturbance of the process of endochondral ossification during skeletal growth. Osteochondrosis is considered the main reason for leg weakness in pigs, which is the second reason for culling in sows, after fertility problems. Previous studies suggest there is a relationship between OC and growth. However, little is known about this relationship, in particular about the timeframe in which growth influences ossification. The aim of the study was to identify the age at which growth and OC are related, and whether this relationship differs between joints. To understand the relationship between the growth pattern and the onset of OC, repeated body weight (BW) measurements and OC scores of 345 pigs were collected. An average of 17 body weight measurements from birth until slaughter at 6 months of age was used. OC was scored macroscopically after slaughter in 24 locations of five joints. Pigs were divided in three defined groups based on the severity of OC; no OC, minor, or severe OC.Until weaning at day 21 no differences in weight and gain were found between the three defined groups. From weaning onwards, pigs diagnosed with minor or severe OC showed higher BWs than pigs diagnosed without OC. The higher weights were due to increased growth before the age of three months. This period might coincide with the window of susceptibility for OC in pigs. The relationship with growth seems to be joint-dependent. Pigs with OC in the elbow joints or with OC in two joints had high BWs, whereas pigs with OC in the femoropatellar joints had low BWs compared to mean BW. Determination of the window of susceptibility and of the relationship between weight gain and OC may help in developing strategies to reduce OC in pig populations.     

Clinical experiences of treating septic arthritis in the equine by repeated joint lavage: a series of 39 cases

The condition of septic arthritis was treated in 12 foals with 21 affected joints (Group I) and in 27 adult horses. The adult horses were divided into three groups, based on aetiology of the condition: haematogenous (Group II, n = 6), iatrogenic (Group III, n = 6), and perforating trauma (Group IV, n = 15). The treatment consisted of an initial systemic antibiotic that anticipated the microbial agents that were considered most likely per group, repeated through-and-through joint lavages every other day and non-steroidal anti-inflammatory drugs. The antibiotics were adjusted to the results of bacteriological culture and susceptibility tests. Joint lavages were continued until the white blood cell count dropped below 15 G/l and bacteriological culture was negative, after which a single dose of a short-acting corticosteroid was administered intra-articularly. Joint recovery rate in group I was 71%. Patient recovery rate of the foals, however, was lower (42%). Three foals were killed for reasons other than arthritis; one foal because of an arthritis-related problem and three foals because of persistent arthritis. Overall joint recovery rate, equalling patient recovery rate, in the adult horses was 81%. The expected predominance of Streptococcus spp. in haematogenous arthritis in adult horses was not confirmed, indicating that in these cases also, an initial antibiotic treatment with a broad-spectrum combination is preferable. It is concluded that with intensive treatment, the prognosis of septic arthritis in the adult horse can be classified as fair to even good. Results in the foals are not as good, but this seems to be more due to the specific problems surrounding the equine neonate than to unresponsiveness to the treatment.     

Field study of the prevalence of lameness in horses with back problems

A population of 805 horses (70 per cent dressage, 20 per cent show jumpers and 10 per cent trotters) with orthopaedic problems was examined for signs of lameness and back problems, irrespective of their original complaints. In the horses with a back problem the prevalence of lameness was 74 per cent, and back problems were diagnosed in 32 per cent of the lame horses. These percentages were significantly higher than those recorded in a control population of 399 horses, of which 20 per cent were lame and 12 per cent had back problems. In the group of horses with orthopaedic problems there was a strong association between lameness and back problems and, in particular, there was a high prevalence of lameness among the horses with back problems.     

Differences in the topographical distribution of articular cartilage degeneration between equine metacarpo- and metatarsophalangeal joints

REASONS FOR PERFORMING STUDY: The equine metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints, although having virtually the same geometrical appearance, differ in the prevalence of joint pathologies, such as osteochondral fragmentation, and in biomechanical behaviour. The recently developed cartilage degeneration index (CDI) technique offers a possibility to assess quantitatively differences in cartilage degeneration between these joints and to compare these with known differences in biomechanics and clinical observations. OBJECTIVES: To compare the topographical distribution of articular cartilage degeneration across the proximal articular surface of the proximal phalanx (P1) in the equine fore- and hindlimb. METHODS: In 24 distal hindlimbs from 24 horses, articular cartilage degeneration of the proximal articular surface of P1 was quantified using the CDI. Overall CDI value (CDI(P1)) and CDI values of 6 areas of interest were determined: the medial dorsal surface (mds), lateral dorsal surface (lds), medial central fovea (mcf), lateral central fovea (lcf), medial plantar surface (mps) and lateral plantar surface (lps). The joints were divided into 4 equally sized groups of increasing CDI(P1) values. From an existing CDI database of MCP joints, 24 joints were selected with matching CDI(P1) values to the MTP joints and CDI values for the same areas of interest were determined. RESULTS: In both the MCP and MTP joints, highest CDI values were determined at the dorsal articular surfaces. Values were not significantly different between fore- and hindlimbs. In contrast to the MCP joint, CDI values at the plantar joint margin were significantly higher compared to CDI values in the central sites in the MTP joint. CDI values for the plantar surfaces of P1 were significantly higher than those for the palmar surfaces in the forelimb in joints with advanced stages of OA; and values for the central regions of P1 were significantly lower in the hindlimb compared with the forelimb in joints with severe OA. CONCLUSIONS: In both fore- and hindlimbs, initial cartilage degeneration started at the dorsal articular margin of P1. There was a major difference in the spread of cartilage degeneration; in the forelimb both the central and palmar parts are about equally involved, whereas in the hindlimb the plantar parts were significantly more and the central parts significantly less involved. These differences can be linked to differences in biomechanical loading reported elsewhere. POTENTIAL RELEVANCE: This study supports the hypothesis that differences in biokinematics between fore- and hindlimbs are associated with differences in the development of cartilage degeneration and other joint pathologies such as osteochondral fragmentation in the MCP and MTP joints. This information is indispensable for a better understanding of the dynamic nature and progression of these joint disorders and may be of help when monitoring the effects of therapeutic interventions and preventative measures.     

Investigation of Keyes skin biopsy instrument for intestinal biopsy versus a standard biopsy technique

A prospective, clinical trial was conducted using 12 dogs that were presented for intestinal biopsy. Comparisons were made between paired jejunal biopsies collected using a Keyes biopsy punch and a standard scissor excisional technique. There were no differences in speed of collection, diagnostic value of specimens, complication rates, or sample quality. In this study, the Keyes skin punch was found to be safe, rapid, and diagnostic in all animals. Based on results of this study, the use of a Keyes punch instrument can be recommended as an alternative to other open intestinal biopsy methods.     

Ca2+ ATPase in Dutch warmblood foals compared with Na+, K+ ATPase: intermuscular differences and the effect of exercise

We studied the effects of exercise without or with a subsequent period on pasture on Ca2+ ATPase concentration in foal skeletal muscle, and compared the results with those previously reported on Na+, K+ ATPase. Ca2+ ATPase was measured in homogenates as Ca2+-dependent steady-state phosphorylation from [gamma-32P]ATP. From day 7 after birth, 24 foals were divided into three groups: (i) staying in a box stall (Box); (ii) staying in a box stall with an exercise programme of an increasing number of sprints per day (Exercise); and (iii) staying on pasture (Pasture). Half of the foals (12 with four in each treatment group) were killed after 5 months. The remaining foals stayed on pasture until 11 months. In the 5-month Pasture group, Ca2+ ATPase concentration was 29.4 +/- 4.3 nmol/g wet weight (wt) (n = 4) in gluteus medius muscle, 25.2 +/- 3.3 nmol/g wet wt (n = 4) in semitendinosus muscle (both mixed fibre type), and 4.1 +/- 1.7 nmol/g wet wt (n = 3) in the slow masseter muscle. These values were not altered by exercise or by box rest. This was in contrast to the Na+, K+ ATPase concentration which was not different between the three muscles, but showed a 20% rise in gluteus medius and semitendinosus muscle after exercise. In the period from 5 to 11 months on pasture, there was no change in Ca2+ ATPase in any group. In conclusion, the Ca2+ ATPase concentration in foal muscle is around 6-fold higher in mixed fibres than in slow fibres. Furthermore, the enzyme is not up- or down-regulated by sprint exercise or subsequent rest.     

Long-term follow-up of manipulative treatment in a horse with back problems

In order to objectively quantify the effect of manipulation on back-related locomotion anomalies in the horse, a recently developed kinematic measuring technique for the objective quantification of thoracolumbar motion in the horse was applied in a dressage horse that was suffering from a back problem. In this horse, clinically, a right-convex bending (scoliosis) from the 10th thoracic vertebra to the second lumbar vertebra was diagnosed. As a result, there was a marked asymmetric movement of the thoracolumbar spine. Functionally, there was severe loss of performance. Thoracolumbar motion was measured in terms of ventrodorsal flexion, lateral flexion, and axial rotation using an automated gait analysis system. Measurements were repeated before and 2 days after treatment, before the second treatment 3 weeks later, and at 4 weeks and 8 months after the second treatment to assess long-term effect. At the same time, performance of the horse was assessed subjectively by the trainer as well. Symmetry of movement improved dramatically after the first treatment. After this, there was a slight decrease in symmetry, but 8 months after the last treatment the symmetry indexes for the various joints were still considerably better than during the first (pre-treatment) measuring session. Subjectively, the trainer did not notice improvement until after measurement session 4. Between sessions 4 and 5 (at 4 weeks and 8 months after the second treatment) there was a change of trainer. The new trainer did not report any back problem, and succeeded in bringing the horse back to its former level in competition. It is concluded that manipulation had a measurable influence on the kinematics of the thoracolumbar spine. However, it is recognized that an improvement in symmetry of motion is not equivalent to clinical improvement and that other measures, such as changes in management, may be more decisive.     

Computerized ultrasonographic tissue characterization of equine superficial digital flexor tendons by means of stability quantification of echo patterns in contiguous transverse ultrasonographic images

OBJECTIVE: To describe a method of computerized ultrasonographic tissue characterization that includes structures below the size limits of resolution in equine superficial digital flexor tendons. SAMPLE POPULATION: 2 damaged and 2 structurally normal superficial digital flexor tendons. PROCEDURE: Transverse ultrasonographic images were collected along the tendon long axis. Stability of echo pattern was quantified by means of variation in gray levels of each pixel in contiguous images and expressed as correlation, entropy, and waviness ratios. RESULTS: Normal young and normal old tissues were characterized by high correlation and low entropy and waviness ratios. In necrotic tissue, collapsed intratendinous septa resulted in high correlation, moderate entropy, and high waviness ratios. In early granulation tissue, complete lack of bundle formation resulted in values of zero for correlation and waviness ratios; loose connective tissue matrix resulted in a high entropy ratio. In late granulation tissue, formation of new bundles resulted in a high correlation ratio; swollen intratendinous septa and incomplete organization of connective tissue matrix were reflected in high entropy and waviness ratios. In early fibrotic tissue, rearrangement of tendon bundles resulted in a correlation ratio within reference range and a slight increase in the waviness ratio; an increase in cellularity and lack of fibrillar arrangement led to an increase in the entropy ratio. In late fibrotic and scar tissues, inferior quality of repair with almost complete lack of organization was reflected in low to moderate correlation, low waviness, and high entropy ratios. CONCLUSIONS AND CLINICAL RELEVANCE: Stability of echo patterns accurately reflects homogeneity of tendons in horses.