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Biomedical subjects

A J Dart

Publications and source records attributed to A J Dart.

At least 19 recordsLinked to original sources

Enteral fluid therapy in large animals.

Enteral fluids administered alone, or in conjunction with intravenous fluids, are reported to be useful for the treatment of dehydration and electrolyte loss associated with diarrhoea in a number of species, following exercise in horses and for feed impaction of the large intestine of horses. Enteral fluids are suitable for treatment of mild to moderately dehydrated patients with some intact intestinal epithelium and motile small intestine. In patients that will drink voluntarily or tolerate nasal intubation the use of enteral fluids may avoid the complications associated with intravenous fluid administration. However the labour costs associated with repeated nasal intubation in intensively managed patients requiring large volumes of fluids may make the use of enteral fluids less economical than intravenous fluid administration. Enteral fluid use alone is contraindicated in patients that are severely dehydrated and/or in hypovolaemic shock, however, if used in conjunction with intravenous fluids, the effects of villous atrophy and malnutrition may be ameliorated and the duration of hospitalisation shortened. There is a variety of commercially available enteral fluids available to veterinary practitioners. While the key components of these fluids are sodium, chloride and carbohydrates, the amounts of ions and other ingredients such as potassium, alkalising agents, amino acids and shortchain fatty acids may vary. The species of the animal, the underlying condition, and the constituents of the fluid, should influence the choice of an enteral fluid.

Animals↗

Recent advances in equine abdominal surgery.

Laparoscopy is a minimally invasive procedure that has applications as a diagnostic, therapeutic and prognostic technique. Specialized equipment is necessary to perform equine laparoscopy, and there is a large range of instruments, both disposable and non-disposable available. Laparoscopic procedures described include ovariectomy, cryptorchidectomy, adhesiolysis and herniorrhaphy. Laparoscopy can be performed in a standing or dorsally recumbent position, depending on surgeon preference, patient status and the procedure to be performed. Stapling equipment is frequently used in gastrointestinal surgery in horses. Advantages include decreased surgical time and a decrease in the risk of contamination. Stapling equipment is often used in creating anastomoses, both in the large and small intestines, as well as in vessel ligation. New surgical techniques intended to decrease adhesion formation include the use of carboxymethylcellulose and bioresorbable patches. Indwelling abdominal drains can be used for peritoneal lavage following surgery and also appear to decrease the risk of adhesion formation. Improvements in post-operative care, including the treatment of post-operative ileus and endotoxaemia can significantly improve the outcome of horses that have undergone surgery for abdominal disorders. Recommendations for the use of prokinetic agents in horses with ileus vary widely. Prokinetic agents include local anaesthetics, macrolide antimicrobials, cholinergic agonists and dopamine antagonists. Endotoxaemia is common in horses following surgery for gastrointestinal disorders. The antibiotic polymyxin B binds to the circulating endotoxin molecule, decreasing its half-life in the intra-vascular space and reducing associated inflammation. This drug appears to be an effective and affordable treatment option for horses with endotoxaemia. The use of specific cyclooxygenase inhibitors in veterinary medicine have been studied recently. Selective cyclooxygenase-2 inhibitors may provide comparable anti-inflammatory and analgesic properties to the non-selective non-steroidal anti-inflammatory drugs. These drugs appear to have similar clinical effectiveness and will hopefully minimize deleterious side effects. The optimal healing of ventral midline incisions in horses is related to many factors including appropriate suture patterns and bite size, in addition to appropriate post-operative exercise recommendations. Recent advances in surgical techniques and post-operative care should decrease the morbidity and mortality associated with abdominal surgery. This article provides an overview of some of these advances.

Abdomen↗

Mechanical and functional properties of the equine superficial digital flexor tendon.

The in vitro and in vivo mechanical properties of the superficial digital flexor tendon have been described. To date the focus has been on single load to failure testing, however refined in vivo methods may prove useful to evaluate the effects of treatment and exercise on tendons. During maximal exercise, the adult superficial digital flexor tendon operates close to its functional limits with a narrow biomechanical safety margin. This combined with exercise and age associated microdamage, and a limited adaptive ability may increase the risk of fatigue failure. Studies evaluating treatment regimens for tendonitis have focused on repair and regeneration and yielded varying results. It would appear that the superficial digital flexor tendon has a limited ability if any to adapt positively to exercise after maturity. In contrast, the foal's superficial digital flexor tendon may have a greater adaptive ability and may respond to an appropriate exercise regimen to produce a more functionally adapted tendon. Recent studies have shown that foals allowed free pasture exercise develop a larger, stronger, more elastic tendon compared to foals that were confined or subjected to a training program. Effects on the non-collagenous matrix appear to be responsible for these differences. In contrast, training or excess exercise may have permanent detrimental effects on the biomechanical and functional properties of the superficial digital flexor tendon in the foal. The implication is that the determination of optimum exercise intensity and timing, and the role of the non-collagenous matrix in tendon physiology in the young horse may hold the key to developing tendons more capable of resisting injury.

Aging↗

Surgical repair of a cleft soft palate in an alpaca.

A 26-day-old entire male alpaca was referred for surgical treatment of a cleft soft palate. Mandibular symphysiotomy and three-layer closure of the palatal defect resulted in primary intention healing. Despite complications related to anaesthesia the alpaca made a full recovery.

Anesthesia↗

Treatment of long bone fractures in South American camelids: 5 cases.

An adult llama and four alpacas were referred with long bone fractures. The llama presented with a closed, comminuted fracture of the right metatarsal bones. Two of the alpacas presented with comminuted fractures of the proximal radius. One fracture was closed and one was open. One alpaca had a closed, comminuted fracture of the distal radius, and the final alpaca had a closed, oblique fracture of the metatarsus. A diagnosis was made in each animal on the basis of clinical examination and radiographs. All fractures were managed by open reduction and internal fixation using selective placement of lag screws and dynamic compression plates. Four animals made uneventful recoveries and no long-term complications were encountered. One alpaca was re-admitted for plate failure and non-union of the fracture 5 weeks after surgery. The plate and screws were removed and a transfixation cast was applied. The fracture healed, however the alpaca showed signs of radial nerve paralysis after the cast was removed. With confinement in a small yard, full function gradually returned to the leg over the ensuing 4 months. Using techniques recommended in other species, South American camelids are suitable candidates for long bone fracture repair using open reduction and internal fixation.

Animals↗

Unilateral nephrectomy as a treatment for renal trauma in a foal.

A 2-day-old Warmblood colt foal was referred for evaluation of progressive abdominal distension and lethargy. Haemoperitoneum was diagnosed and a ventral midline laparotomy revealed capsular rupture, sub capsular haematoma and haemorrhage of the left kidney. Unilateral nephrectomy was performed and the foal recovered uneventfully, with no reported complications 1 year later.

Animals↗

Catheters: a review of the selection, utilisation and complications of catheters for peripheral venous access.

Intravenous catheters are used for the administration of medications and fluids and are an integral part of veterinary practice. The aim of catheter use is to optimise administration of medication and minimise complications such as thrombus formation, thrombophlebitis and sepsis. Catheters made from teflon are less flexible, less durable and stimulate more tissue reaction than polyurethane or silicon. However silicon catheters are more expensive and complicated to insert. Generally, for veterinary practice, the biostability and cost of polyurethane catheters make them preferable for short and long-term use. The smallest diameter catheter should be selected to minimise internal vessel wall contact and irritation without compromising medication delivery. The site of insertion varies with individual preference, vessel access and patient compliance. The jugular, cephalic, saphenous, ear, lateral thoracic and subcutaneous abdominal veins are accessible. Hair removal and a thorough aseptic skin preparation should be performed prior to catheter insertion. Daily maintenance is required to detect complications and maximise catheter longevity. Potential complications include thrombus formation, thromboembolism, bacterial colonisation and septicaemia, blood loss and air embolism. Permanent or transient skin dwelling bacteria are commonly isolated if sepsis occurs. The development of novel antiseptic and antibiotic impregnated catheters may reduce the complications associated with catheter infection in the future.

Animals↗

Suture materials: composition and applications in veternary wound repair.

Suture materials play an important role in veterinary surgery by providing support for healing tissues during wound repair. As there is no single ideal suture material, clinicians must compromise on some properties when selecting a material for a specific purpose. By reviewing the characteristics of absorbable and non-absorbable materials, general recommendations can be made on their usage in skin, fascia, viscera and other tissues.

Absorbable Implants↗

Palmar digital neurectomy in 24 horses using the guillotine technique.

OBJECTIVE: To determine the effectiveness and incidence of complications of palmar digital neurectomy using the guillotine technique in horses presented for lameness originating from sites innervated by these nerves. DESIGN: Retrospective study of 24 clinical cases. ANIMALS: Twenty-four horses undergoing a palmar digital nerve neurectomy between June 1997 and June 2001. METHODS: The records of all horses undergoing a uniaxial or biaxial, unilateral or bilateral neurectomy during the defined time period were retrieved. Information retrieved from the record included breed, age, gender, discipline for which the horse was used, history, results of lameness examination, results of perineural anaesthesia, radiographic findings, surgery report, postoperative care, complications and outcome. RESULTS: Seventeen geldings and seven female horses of mixed breeds, ranging in age from 1 to 16 years, that were used for a variety of non-racing, but competitive, athletic disciplines, underwent neurectomy using the guillotine technique during the specified time period. In 23 horses perineural anaesthesia was performed at the University Veterinary Centre to isolate the lameness. Anaesthesia resolved lameness in 18 horses. In five horses there was some residual lameness isolated to sites remote from the distal extremity. The most common radiographic finding was an increase in the number and or size of the synovial fossae of the navicular bone. Twenty-two horses underwent bilateral biaxial neurectomies and two horses with painful trauma-induced neuromas underwent unilateral, uniaxial neurectomy. There were no postoperative complications. All horses were rested for 3 months before returning to work. At least 1 year after surgery, 22 horses were in full work and two horses were not in work because of unrelated problems. Of the horses in work, 17 were considered free of lameness. The other five were competing, but receiving medication for residual lameness associated with sites remote from the distal extremity. CONCLUSION: Results of this study suggested that palmar digital neurectomy using the guillotine technique provided reliable and consistent resolution of lameness originating from sites innervated by these nerves. There were no significant complications.

Animals↗

Results of surgical treatment of colic in miniature breed horses: 11 cases.

OBJECTIVE: To report on the outcome of surgical treatment of acute abdominal crises in miniature breed horses. DESIGN: Retrospective case series of miniature horses presented to the University Veterinary Centre, Camden with an acute abdominal crisis. METHODS: Hospital records of all miniature horses that underwent ventral midline laparotomy for acute abdominal crisis between 1997 and 2001 were reviewed. The signalment, history, clinical signs, results of ancillary diagnostic procedures, location and type of intestinal lesion, treatment and outcome were retrieved from each case record. Long-term survival was determined by telephone interview of owners. RESULTS: Eleven miniature horses including five females and six males underwent ventral midline laparotomies for acute abdominal crisis during the study period. Ages ranged between 1 month and 19 years. Surgical findings included faecalith obstruction (seven horses), enterolith (one horse), strangulating lipoma of the descending colon (one horse), jejunal infarction (one horse), and caecal infarction (one horse). Long-term survival rate (minimum 12 months post surgery) was 55%. Six of eight horses with simple intraluminal obstructions survived, while the three horses with gastrointestinal lesions associated with vascular compromise were euthanased either at surgery (caecal infarction), or postoperatively, due to complications (strangulating lipoma of the descending colon, jejunal infarction). Postoperative complications in this study included impaction of the descending colon (two horses), diarrhoea (two horses), peritonitis (one horse), hyperlipaemia (two horses), incisional infection (two horses) and abdominal adhesions (one horse). Hyperlipidaemia was present in five of seven horses in which serum triglycerides were measured at presentation. CONCLUSIONS: Simple intraluminal obstructions of the large intestine were frequently encountered during exploratory laparotomy in miniature horses presented for acute abdominal crises, and their surgical treatment was associated with a good prognosis. In contrast, this study suggested that abdominal pain associated with vascular compromise of gastrointestinal tissues in miniature horses was associated with a poorer prognosis, consistent with reports in other horse breeds. Possible contributing factors to faecalith formation, including poor quality roughage, dental disease, and inadequate water consumption, should be recognised and avoided in miniature horses. Serum triglyceride concentrations should be measured in miniature horses presented for acute abdominal pain. If elevated, nutritional supplementation should be provided.

Abdominal Pain↗

Surgical repair of a coxofemoral luxation in an alpaca.

A female breeding alpaca with acute lameness of the left hindleg was diagnosed with a craniodorsal coxofemoral luxation. Repair was achieved using extracapsular stabilisation. Two nylon sutures were passed through a hole drilled in the femoral neck and anchored to the dorsal acetabulum using two screws and two spiked washers. A metal crimp was used to tighten and maintain the sutures. Postoperatively the alpaca was confined to a stall for 4 weeks before being returned to a paddock. At 6 months after surgery the alpaca was free of lameness and was successfully mated.

Animals↗

Recombinant equine growth hormone administration: effects on synovial fluid biomarkers and cartilage metabolism in horses.

REASONS FOR PERFORMING STUDY: Recombinant equine growth hormone (reGH) has recently been evaluated for effects on body condition and wound healing. It has the potential to influence articular cartilage via stimulation of IGF-1. OBJECTIVES: To investigate effects of administration on synovial joint metabolism. METHODS: Six mature horses were given 20 microg/kg bwt reGH daily for 8 weeks by i.m. injection. Three control horses were injected with sterile water. Serum and synovial fluid samples were collected at 6, 8, 11 and 16 weeks for GH and IGF-1 assays. Articular cartilage harvested at week 16 was evaluated by Western analysis using monoclonal antibodies BC-13, BC-4, 8-A-4 and CH-3. RESULTS: Concentrations of IGF-1 in serum and synovial fluid were significantly elevated (P < 0.05) at 6 and 8 weeks in the reGH group. Glycosaminoglycan concentrations in synovial fluid were significantly less than controls at these time points, suggesting that reGH may modulate proteoglycan metabolism in articular cartilage. In the reGH group, there were not any alterations in synovial fluid content of 3B3(-) epitope or aggrecan metabolite, or in aggrecan or link protein catabolites retained within cartilage, that might be expected with development of osteoarthritis. CONCLUSIONS: Intramuscular administration of reGH may be a more efficient means of delivery of IGF-1 to joints for cartilage resurfacing initiatives. POTENTIAL RELEVANCE: We found no alterations in cartilage metabolism indicative of development of osteoarthritis.

Animals↗

Predictive values, sensitivity and specificity of abdominal fluid variables in determining the need for surgery in horses with an acute abdominal crisis.

OBJECTIVE: To determine the predictive values, sensitivity and specificity of abdominal fluid variables associated with the need for surgery in horses with an acute abdominal crisis. DESIGN: Retrospective study. ANIMALS: Two-hundred and thirty-six horses examined for signs of abdominal pain between January 1993 and June 1999. METHODS: Breed, age and gender of the horse and colour, total protein concentration and total nucleated cell count of an abdominal fluid sample were recorded. Colour of the abdominal fluid was classified as normal if it was yellow and transparent. Turbid fluid or fluid that was serosanguinous or other colours was classified as abnormal. Protein concentration < or = 20 g/L and a total nucleated cell count < or = 5 x 10(9) cells/L were considered normal and values above these were considered abnormal. An abdominal fluid sample was classified as abnormal if one or more of the three variables were considered abnormal. Cases were defined as surgical when lesions identified at surgery or necropsy examination would not have resolved with medical treatment alone. Cases were defined as medical in horses that survived without surgical intervention, and those with a lesion found at surgery or necropsy that would have resolved with medical treatment alone. A third category was identified during the study as those diagnosed with Actinobacillus equuli--induced peritonitis. These horses were included in the study but not in the data analysis. DATA ANALYSIS: The association between the sensitivity, specificity and positive and negative predictive value of colour, total protein, and total nucleated cell count in the abdominal fluid and the need for surgery was calculated. RESULTS: There were 100 females and 136 males of mixed breeds, ranging from 3 days to 26 years of age that had an abdominocentesis performed during the specified period. There were 97 horses with a lesion classified as surgical, 91 horses with a lesion classified as medical and 48 horses with a diagnosis of A equuli-induced peritonitis. Colour of the abdominal fluid was recorded in all horses, protein concentration was recorded in 194 horses and total nucleated cell count was recorded in 179 horses. Abnormal abdominal fluid colour had a sensitivity, specificity, positive and negative predictive value of 92%, 74%, 79% and 89% respectively, associated with the need for surgery. Sensitivity, specificity, positive and negative predictive values for a serosanguinous abdominal fluid sample associated with the need for surgery were 48%, 99%, 98% and 64% respectively. Abnormal abdominal fluid protein concentration had a sensitivity, specificity, positive and negative predictive value of 86%, 75%, 77% and 85% respectively, associated with the need for surgery. The sensitivity, specificity, positive and negative predictive value associated with the need for surgery in horses with an abnormal total nucleated cell count in the abdominal fluid were 59%, 75%, 67% and 67%, respectively. An abdominal fluid sample classified as abnormal had a sensitivity, specificity, positive and negative predictive value of 92%, 74%, 79% and 89% respectively, associated with the need for surgery. CONCLUSION: Results of this study suggest that abdominal fluid sample analysis contributes to the decision to proceed to surgery, but is not a diagnostic panacea. Colour and protein concentration of abdominal fluid were the most useful variables in abdominal fluid for differentiating medical and surgical lesions. Colour and protein had a greater value in horses with a disease likely to respond to medical treatment (negative predictive value) than those with a lesion requiring surgery (positive predictive value) except when the fluid was serosanguinous. Abdominal fluid colour and protein are clinically relevant and easily measured in the field, providing immediate information without the need for sophisticated laboratory techniques.

Abdomen, Acute↗

Correlation of cartilage oligomeric matrix protein (COMP) levels in equine tendon with mechanical properties: a proposed role for COMP in determining function-specific mechanical characteristics of locomotor tendons.

Over-strain injury of the superficial digital flexor tendon (SDFT) is a common injury in the horse. Tendon appears to adapt to loads placed on it during development, but fatigue damage accumulates after skeletal maturity, which is inadequately repaired and predisposes to clinical tendinitis. In any population of horses, there is a wide variation in SDFT mechanical properties. A noncollagenous protein, cartilage oligomeric matrix protein (COMP), is particularly abundant during growth in the equine SDFT and has been proposed to have an organisational role in the formation of collagenous matrices. This study aimed to determine whether COMP levels were correlated to mechanical properties at skeletal maturity. Tendons from 2 groups of 12 horses were analysed: Group 1 horses with restricted age, 2 years +/- 2 months, showed a significant correlation between both ultimate tensile stress modulus of elasticity and stiffness and COMP, while Group 2 mature horses with varying age did not, because of age- and exercise-induced loss of COMP. These data supports the hypothesis that COMP is an important mediator in the growth of tendon. This data would suggest that the identification of low COMP levels in tendon during growth would indicate horses prone to tendon injury and methods of promoting COMP synthesis during growth would potentially improve tendon quality and reduce the risk of subsequent tendinitis.

Age Factors↗