Surgical treatment of synovial sepsis: Is endoscopy the best approach?

Treatment of synovial sepsis (septic arthritis, bursitis and tenosynovitis) typically involves surgical lavage of the infected synovial cavity(ies). The two most used techniques are through-and-through needle lavage and endoscopic lavage. Endoscopic lavage is considered to have several advantages, and anecdotally, there appears to be a general shift towards favouring this technique. However, there are only a limited number of published studies directly comparing the outcomes of the two treatment techniques. The available published literature suggests that the outcomes (short-term survival, return to work) are comparable. Further studies are required to expand the available veterinary literature and to assess such factors as the costs associated with the different treatment methods. A variation in diagnostic values used for diagnosing synovial sepsis is apparent in the current literature and further clarification of inclusion/diagnostic criteria would be useful for clinicians.     

The role of tissue factor and tissue factor pathway inhibitor in health and disease states

Objective – To review the veterinary and human literature on the role of tissue factor (TF) and tissue factor pathway inhibitor (TFPI) in health and disease states.
Data Sources – Original research articles and scientific reviews from both human and veterinary literature were searched for relevance to TF and TFPI.
Human Data Synthesis – Interest in both TF and TFPI has grown widely over the last several years. The impact TF plays in coagulation, inflammation, angiogenesis, tumor metastasis, and cellular signaling has become apparent. Treatment with TFPI for severe sepsis has been examined and is still currently under investigation. Inhibition of the TF pathway is being studied as an aid in the treatment of neoplasia. The important physiologic and pathophysiologic role these molecules play has only begun to be understood.
Veterinary Data Synthesis – There is a paucity of publications that discuss the importance of TF and TFPI in veterinary medicine. An enhanced understanding of the TF pathway in human medicine, in experimental animal models treating sepsis with TFPI, and in animal models demonstrating the proangiogenic properties of TF provides relevance to veterinary medicine.
Conclusion – It is apparent that TF and TFPI are important in health and disease. An enhanced understanding of the physiologic and pathophysiologic roles of these factors provides better insight into coagulation, inflammation, angiogenesis, disseminated intravascular coagulation, and tumor metastasis. This greater understanding may provide for the development of therapeutics for sepsis, disseminated intravascular coagulation, and neoplasia.     

Multiple organ dysfunction syndrome in humans and dogs

Objective: To describe the clinical appearance and theories on the pathogenesis of multiple organ dysfunction syndrome (MODS) in humans, and to review the evidence suggesting that a similar syndrome occurs in critically ill dogs. Human‐based studies: Currently, there are a multitude of publications describing the pathogenesis and clinical course of MODS in humans. Providing much of the basis for on‐going research and the development of clinical applications, a consensus statement made by the American College of Chest Physicians and Society of Critical Care Medicine defined parameters that had guided and shaped much of what is known about MODS. Veterinary‐based studies: To date, there are few publications describing MODS in dogs and much of what is known has been derived from case reports and reviews of various critical illnesses in dogs. While a similar syndrome of multiple organ dysfunction likely exists in dogs, a consensus statement defining clinical parameters has not been made. Data sources: Veterinary and human literature review. Conclusions: The development of MODS in human critical illness is widely recognized and major strides have been made in the understanding of this complex syndrome. Scoring schemes applied to human MODS patients have established that with increasing numbers of failing organs, there is a worse prognosis. As a similar finding likely exists in dogs, an awareness of MODS is vital to veterinary critical care clinicians and a consensus definition of MODS in dogs is warranted.     

黄连解毒汤加味对脓毒症热毒炽盛证患者血流动力学和微循环灌注的影响

目的 探讨黄连解毒汤加味对脓毒症热毒炽盛证患者血流动力学及微循环灌注的影响。方法 选取符合诊断标准的患者60例,按随机数字表法将患者分为观察组30例及对照组30例,对照组患者采用传统抗感染、对症支持、稳定内环境等西医常规治疗,观察组患者在对照组的基础上加用黄连解毒汤加味治疗。观察两组患者治疗前及治疗后24 h、48 h血流动力学及微循环灌注指标的变化。结果 治疗24 h、48 h后,两组患者心率（heart rate, HR）、平均动脉压（mean arterial pressure, MAP）、中心静脉压（central venous pressure, CVP）、体循环阻力（systemic vascular resistance, SVR）、血管活性药用量（norepinephrine, NE）、血乳酸（blood lactic acid, LAC）、混合静脉血血氧饱和度（oxygen saturation of mixed venose blood, SCVO₂）、动静脉二氧化碳分压差（significance of venoarterial carbon dioxide difference, Pcv-aCO₂）均较治疗前明显改善（P<0.05）,且观察组各项指标较对照组改善明显（P<0.05）。结论 对脓毒症热毒炽盛证患者联合应用西医常规配合黄连解毒汤加味治疗,可以有效改善患者血流动力学指标及组织低灌注水平,为临床治疗提供参考。     

Phosphorus and phosphate metabolism in veterinary patients

Objective: To review phosphorus and phosphate metabolism and the importance of phosphate abnormalities in veterinary patients. Data sources: A review of recent human and veterinary medical literature. Human data synthesis: There is a significant amount of original research on human patients with phosphate abnormalities. Hypophosphatemia has been studied in patients with diabetic ketoacidosis (DKA), head trauma, refeeding syndrome, hypothermia and in ventilator patients that fail to wean. Hyperphosphatemia has been studied in patients with renal failure and malignancy. Phosphate levels have also been evaluated for prognostic value in sepsis and acute liver failure. Veterinary data synthesis: Although animal models were used in early experimental research, fewer studies have been published on the effects of phosphate abnormalities in veterinary patients. Hypophosphatemia has been studied in animals with DKA, with refeeding syndrome and with hyperparathyroidism. Hyperphosphatemia has been studied in animals with renal failure and with secondary hypoparathyroidism. Conclusion: Phosphorus and phosphate are important in many biological functions. This paper is a review of their role in normal metabolism and the clinical importance of phosphate imbalances for our emergency and critical care patients.     

Partial mandibular condylectomy and temporal bone resection for chronic,destructive, septic arthritis of the temporomandibular joint in a horse

Sepsis of the temporomandibular joint (TMJ) of the horse is rare. This case report describes the use of radiography, ultrasonography and computed tomography to diagnose sepsis of the TMJ in a 2‐year‐old Thoroughbred filly. The mandibular condyle and temporal bone were partially resected to successfully remove necrotic tissue within and surrounding the TMJ. Sepsis resolved and the horse returned to race training. Follow‐up computed tomography examination showed generation of a mandibular ‘pseudocondyle’ at 8 months post operatively.