Grid keratotomy as a treatment for superficial nonhealing corneal ulcers in 10 horses

OBJECTIVE: To describe the clinical symptoms of 10 cases of superficial nonhealing corneal ulcers in horses and to evaluate the results of grid keratotomy in these patients. DESIGN: Retrospective study. ANIMALS: Ten horses with superficial nonhealing corneal ulceration in one eye. PROCEDURE: The signalment, history and clinical symptoms are reported of 10 patients with superficial nonhealing corneal ulcers during the period from August 2003 to February 2005. Grid keratotomy was performed in all cases. In addition, the surgical procedure of grid keratotomy and response to therapy are described. RESULTS: Horses generally responded well to grid keratotomy (eight cases healed after one grid keratotomy and one horse healed after a second grid keratotomy; one case was not available for follow-up). Only 2/10 had discomfort after treatment and only 2/9 had some degree of scarring after treatment. The healing time, which was known in seven cases, averaged 8.4 days (+/- SD 4). CONCLUSIONS AND CLINICAL RELEVANCE: Grid keratotomy is an appropriate option for treatment of superficial nonhealing corneal ulcers in horses. The procedure is simple to perform. It generally induces a rapid and uncomplicated healing of the cornea. Only in a limited number of cases does a small amount of scarring occur.     

Relationship between the ultrasonographic findings of suspected superficial digital flexor tendon injury and the prevalence of subsequent severe superficial digital flexor tendon injuries in Thoroughbred horses: a retrospective study

The onset of severe injury to the superficial digital flexor tendon (SDFT) is extremely difficult to predict from slight changes in ultrasonographic findings in cases with no apparent clinical signs. This study investigated the relationship between an increased cross-sectional area (CSA) or edema in the subcutaneous tissue around the tendon and the subsequent onset of severe SDFT injury in Thoroughbred racehorses. Horses were classified into three groups based on ultrasound diagnosis (USD) findings: Group A included cases with enlarged tendons; Group B included cases with tendons of normal size but with prominent edema in the peritendinous tissue; and Group C (control group) included cases with no abnormal USD findings. The incidence of subsequent severe tendon injury was significantly higher in the horses in Groups A (25.7%, 28/101) and B (28.3%, 65/212) than in those in Group C (4.9%, 2/41). There were no significant differences in the median period and the median number of races from the first examination to the subsequent tendon injury between Groups A (140 days, 1 race) and B (120 days, 1 race). The results of this study revealed that horses with increased CSA and peritendinous edema are likely to suffer a subsequent severe tendon injury. Also, these two USD findings, i.e., increased CSA and peritendinous edema, indicate the risk of onset of severe SDFT injury.     

Results of grid keratotomy, superficial keratectomy and debridement for the management of persistent corneal erosions in 92 dogs

Ninety-two cases of persistent corneal erosions in dogs were analyzed for breed, gender, age and which eye was affected. The results of the treatment of 92 persistent corneal erosions in dogs by superficial keratectomy (SK), grid keratotomy (GK), or debridement with a sterile dry cotton swab are presented. These techniques gave better rates of healing than have been previously reported. All cases of persistent corneal erosions healed in this study. However, it must be noted that three cases treated with debridement only failed to heal after several treatments and were eventually treated with SK. After one procedure 80 out of 92 (87%) had healed. After one procedure, 63% of cases treated with debridement healed, 100% of cases treated with SK healed, and 85% of cases treated with GK healed. At the first postoperative visit, 88% (21/24 cases) of ulcers treated by SK had healed, and 75% (39/52 cases) of ulcers treated by GK had healed. Only 25% of the persistent corneal erosions had healed at the first visit after debridement. All 24 cases of persistent corneal erosions treated with SK healed after one treatment in a mean +/- SD of 9.3 +/- 3.9 days (median of 7 days). Fifty-two cases were managed with GK; 44 (83%) of these healed with one procedure and eight cases required a second GK procedure to resolve. A mean +/- SD of 13.4 +/- 5.1 days (median of 11.5 days) following GK was required for the persistent corneal erosions to heal. Nineteen cases were initially managed by debridement with a dry cotton swab under local anesthesia. Sixteen out of these 19 debridement cases healed (giving an overall healing rate of 84%) in a mean +/- SD time of 23.4 +/- 11.1 days (median 21.5). There were three cases that did not heal with debridement. These cases were debrided at 10-20 day intervals for 30-60 days, and were then treated with SK. Two of these cases healed within 7 days, the other case required 18 days to heal. Sixty-three per cent of persistent corneal erosions treated with debridement healed after one procedure; however, only four out of 19 cases (21%) were healed at the first revisit. Complications were rare: corneal edema occurred in two cases following multiple GK, and excessive granulation tissue in one case was managed with a SK. There was the occurrence of an ulcer adjacent to the surgery site in four cases, two cases following GK and two cases following SK.     

Superficial digital flexor tendonitis in Thoroughbred race horses: outcome following non-surgical treatment and superior check desmotomy

Objective This study documents the results of non-surgical treatment and treatment by superior check desmotomy in Thoroughbred racehorses with superficial digital flexor (SDF) tendonitis. Design A prospective study was made of 124 thoroughbred racehorses with unilateral or bilateral SDF tendonitis. Procedure The flexor tendons were assessed by physical and ultrasonographic examination before treatment, and the lesions detected in affected tendons were characterised according to lesion type, length and cross-sectional area. Ninety three horses were managed non-surgically and 31 by superior check desmotomy. Recurrent or new injuries were defined as injuries affecting a previously injured superficial digital flexor tendon, the contralateral SDF tendon, or the suspensory ligament (interosseous muscle) in either forelimb. Results No statistically significant difference was found in ultrasonographic lesion severity between treatment groups. Horses managed by superior check desmotomy were 1.3 times more likely to complete five or more races than horses managed non-surgically (95% confidence limits 0.93–1.82). Horses treated surgically were 1.2 times more likely to develop recurrent or new injuries after returning to training than horses managed non-surgically (95% CL 0.95–1.55). Horses under-going superior check desmotomy were 5.5 times more likely to develop suspensory desmitis than horses treated non-surgically (95% CL 1.13–26.4). There was no difference in the time to recurrent or new injury between treatment groups. Conclusion There was no statistically significant difference between treatment groups in the proportions of horses able to complete five or more races after an episode of superficial digital flexor tendonitis. Superior check desmotomy did not appear to offer an advantage over non-surgical treatment in preventing recurrent or new injuries in Thoroughbred racehorses. Horses undergoing superior check desmotomy appeared to be at greater risk of developing suspensery ligament injuries than horses managed non-surgically.     

Ultrasonographic examination of the tuber calcanei area: Technique and normal ultrasonographic images

Ultrasonographic examination is an essential diagnostic tool that complements radiographic examination in the diagnostic work-up of injury to the tuber calcanei area. Using a plantar approach, the superficial digital flexor tendon, gastrocnemius tendon, the bone surfaces of the two lobes of the tuber calcanei and the gastrocnemius bursa and the calcaneal bursa of the superficial digital flexor tendon (if distended) can be accurately assessed. Using a collateral approach, the tenocalcaneal ligaments of the superficial digital flexor tendon and the branches of the calcaneal tendon of the caudal femoral muscles can be imaged. This paper describes the normal anatomy of the tuber calcanei area and presents the complete ultrasonographic procedure and normal ultrasonographic images of this region.     

Treatment of rupture of suspensory ligament and superficial flexor tendon in a bull

Rupture of the suspensory ligament at the insertions on the proximal sesamoid bones, and of the superficial flexor tendon of the left fore limb, occurred in an adult Angus bull as a result of fighting. There was severe hyperextension of the metacarpophalangeal (MCP) joint with the dewclaws almost touching the ground. Radiographs revealed severe hyper-extension of the MCP joint with the sesamoid bones aligned directly distal to the metacarpus. Initially, a full length fiberglass cast was applied with the limb partially flexed within the cast and the heels elevated. The cast was replaced twice. The cast was removed after 136 days and the bull was bearing full weight on the limb. Prolonged immobilisation of the limb produced new bone in the area (a normal response in cattle) to cause ankylosis of the traumatized MCP joint and partial ankylosis of the carpus. The bull was being used for pasture breeding one year after the injury.     

浅议弱势群体报道中人文关怀的表面化倾向

当下,在对弱势群体的报道中坚持"三贴近"原则、体现人文关怀已经成为新闻媒体的普遍共识。但是,在具体操作过程中,由于多方面的原因,这种人文关怀在很大程度上仅仅流于表面形式。本文旨在指出弱势群体报道中人文关怀的种种表面化现象,并就如何对弱势群体进行真正的人文关怀提出建议。     

HEPATIC ULTRASONOGRAPHIC AND PATHOLOGIC FINDINGS IN DOGS WITH CANINE SURPERFICIAL NECROLYTIC DERMATITIS

A unique, "honeycomb" pattern was found on ultrasonographic evaluation of the liver of 5 dogs with canine superficial necrolytic dermatitis (hepatocutaneous syndrome). This pattern consisted of variably-sized, hypoechoic regions measuring 0.5–1.5 cm in diameter surrounded by highly echogenic borders. Histologically, the hypoechoic regions corresponded to distinct regenerative nodules bounded by severely vacuolated (fat-laden) hepatocytes, numerous bile ductules, and a network of reticulin and fine collagen fibers representing remnants of collapsed hepatic lobules. While certain features of the architectural disruption were characteristic of cirrhosis, the lesion lacked the extensive fibrosis and reduced liver size usually associated with chronic cirrhosis. To our knowledge, this hepatic ultrasonographic pattern has only been seen with canine superficial necrolytic dermatitis. Therefore, it appears to be pathognomonic in a dog with questinable skin lesions. A liver biopsy is required to confirm the unique histopathologic features of the hepatopathy found in this syndrome.     

Superficial keratectomy and cryosurgery as therapy for limbal neoplasms in 13 horses

Objective To determine the usefulness and clinical outcome of a combined procedure of superficial keratectomy and cryosurgery as a treatment for limbal neoplasms in horses. Study design Retrospective study. Animals Thirteen horses with 14 limbal tumors. Methods Medical records of all patients with limbal tumors, referred to the Department of Equine Sciences of Utrecht University between 1995 and 2002, were retrieved. Patient data were analyzed with respect to signalment, tumor surface area and histologic diagnosis. Surgery, performed under general anesthesia, included surgical debulking of the tumor followed by cryosurgery. Long‐term follow‐up information was obtained by re‐evaluation in the clinic, by the referring veterinarian, and/or by telephone enquiry. Results Therapy was successful in 9 out of 14 eyes after the first attempt (64%); one eye needed retreatment (7%), and four eyes were eventually enucleated (29%). The mean follow‐up period was 4.8 years. The initial surface area of the tumor significantly influenced outcome (P < 0.01). Squamous cell carcinoma was the most predominant tumor type (79%). Haflinger horses accounted for 69% of the cases whereas their occurrence in the overall hospital population is approximately 5%. Conclusions and clinical relevance The described technique of superficial keratectomy and cryosurgery is a simple procedure for the treatment of limbal tumors in equine patients that does not require sophisticated equipment. Nor is it tampered by legal restriction, and appears to be effective in tumors with a small surface area (< 2 cm²). Haflinger horses seem to be predisposed for the development of ocular squamous cell carcinoma.