Biomedical subjects
Publications and source records attributed to D M Meagher.
Rational perioperative management improves the success rate of abdominal surgery. Important aspects of management are discussed, including principles of fluid therapy, nutrition, intravenous catheterization, antimicrobial prophylaxis, and the use of nonsteroidal anti-inflammatory medication. Current advances in the area of immunotherapy are mentioned.
Navicular syndrome is a degenerative disorder of the distal half of the flexor surface of the proximal sesamoid bone that is predisposed by faulty foot conformation. In horses that become symptomatic, the faulty conformation results in sustained application of nonphysiologic pressure by the deep digital flexor tendon against the flexor cortex of the bone. This force stimulates an intense bone remodeling response in order to attenuate the pressure. An unfortunate sequela of this response is active hyperemia and edema formation in the medullary cavity of the bone. The edema is organized by fibrous tissue resulting in venous entrapment, venous hypertension, vascular bone pain, and the onset of clinical signs.
Sequelae of routine orotracheal intubation under clinical conditions were characterised in 38 healthy horses presented at three veterinary medical teaching hospitals. Four of these were necropsied and their tissues studied histologically. To minimise variation, 30 mm id cuffed silicone endotracheal tubes or Cole cuffless tubes were used in all patients. Fibreoptic endoscopic examination of upper respiratory and tracheal areas was accomplished pre-intubation, immediately post extubation and after 24 h. Endoscopy revealed that intubation was associated with laryngeal and/or tracheal lesions in all horses. Observations included abundant tracheal mucus, epithelial ecchymoses, basement membrane haemorrhage and mucus covered diphtheritic membrane plaques. Histological examination of lesions from the upper respiratory system of the four necropsied horses confirmed that the damage was comparable to that associated with tracheal intubation and reported in other species.
The medical records of 16 horses with necrosis of the collateral cartilage of the distal phalanx were reviewed. Typical history included a laceration or puncture wound over the affected cartilage, resulting in persistent drainage proximal to the coronary band. All horses had signs of lameness. The duration of drainage prior to admission to the hospital ranged from 5 days to 5 months. The involved cartilages were left front lateral (n = 4), right front lateral (n = 5), left rear lateral (n = 1), right rear lateral (n = 4), left front medial (n = 1), and left rear medial (n = 1). The affected cartilage was curetted or resected in 13 horses, and conservative treatment was used in 3 horses. Follow-up information on 15 horses (2 to 72 months after discharge) revealed that 66% were sound and able to perform at their previous level. One horse was euthanatized 2 months after discharge from the hospital because it had septic arthritis of the distal interphalangeal joint. The outcome of treatment for each horse was evaluated with respect to the duration of drainage and the method of treatment. Horses with drainage of less than 1 month's duration had a better prognosis for eventual soundness, compared with horses with drainage of greater than or equal to 1 month's duration prior to initiation of treatment. Nine of the 13 horses managed surgically and 1 of the 3 horses managed conservatively were sound at follow-up evaluation.
A study was designed to evaluate 2 colopexy techniques (A and B) in 8 clinically normal horses to determine which technique would prevent recurrence of large-colon displacement and/or volvulus. For technique A, 35 cm of the lateral free band of the left ventral colon was sutured to the abdominal wall, 6 cm to the left of ventral midline. For technique B, the medial free band of the left ventral colon was sutured to the medial free band of the right ventral colon, and 8 cm of the lateral free band of the left ventral colon was sutured to the abdominal wall, 6 cm to the left of ventral midline. One horse from each group was euthanatized at 6 months, and another at 12 months after surgery. The position of the large colon, the integrity of the colopexy, and other adhesions within the abdominal cavity were evaluated. At necropsy, attempts were made to manually create displacement and volvulus of the large colon. The remaining horses in each group were anesthetized 6 months or 12 months after surgery, and the integrity of the colopexy was evaluated. After a 60-day recovery period, these horses were exercised for 2 months. Although each horse initially lost weight, the weight of all but 2 was acceptable at the conclusion of the study. Two horses that had technique-B colopexies had progressive weight loss serious enough to warrant euthanasia. Both colopexy techniques prevented manual creation of large-colon displacement and large-colon volvulus centered at the sternal and diaphragmatic flexures. Technique-A colopexy also prevented manual creation of volvulus of the large colon centered at its base.(ABSTRACT TRUNCATED AT 250 WORDS)
Colopexy of the left ventral colon to the abdominal wall was performed in 4 horses with recurrence of large-colon displacement or volvulus. Horses were discharged between 5 and 27 days after surgery. At follow-up evaluation (mean, 10.5 months; range, 7 to 13 months) of the horses, none had recurrence of signs of abdominal pain, and all had normal body weight. Three horses were exercised regularly; signs of abdominal pain were not observed.
Nuclear scintigraphy was used to evaluate healing of third metacarpal bone (MC III) fractures in 2 horses (horses 1 and 2) and a third metatarsal bone fracture in 1 horse (horse 3) after stabilization of each fracture with 2 broad dynamic compression plates. In horse 1, the fracture had uniform uptake of 99mTc methylene diphosphonate on days 1, 15, and 30 after surgery. The fracture healed, and the horse was discharged from the clinic on day 52. In horse 2, a 6-cm photopenic region (ie, area of low radioactivity) was seen over the diaphysis of MC III on day 3. The region persisted and became more distinct by day 32. The diaphysis of MC III sequestered, and horse 2 was euthanatized on day 44. In horse 3, vascularity was seen bridging the fracture on day 5, with a 3-cm photopenic region over the dorsal diaphysis of the third metatarsal bone. By days 18 and 32, uptake of 99mTc methylene diphosphonate in the region had increased, indicating vascularization of the site. the fracture healed, and horse 3 was discharged from the clinic on day 47. Our findings indicated that serial nuclear scintigraphy can be used to evaluate fracture vascularization after surgery in horses.
Three adult horses were admitted with chronic coronary band avulsions of 2-, 3-, and 46-month durations, respectively. The hoof had a typical appearance in all 3 horses, with a spur of coronary band and associated horn growing at right angles to the hoof wall. Each horse was anesthetized, and the coronary band was reconstructed. Follow-up evaluation of the 3 horses (12, 15, and 23 months after surgery, respectively), revealed healing of all 3 avulsed coronary bands. Mild roughening of the hoof wall distal to the previous avulsion site was observed.
Over the past 15 years there has been a substantial increase in the number of cardiac operations being performed. The role of the lay helper volunteer who has successfully recovered from cardiac surgery, offering support to individuals about to undergo similar surgery, is earning a legitimate place in cardiac rehabilitation. This 'living proof' model of support appears to have a significant buffering effect through increasing the cardiac patients' readiness for cardiac surgery and motivation for cardiac rehabilitation. Most literature focuses on individuals who have suffered a myocardial infarction rather than those who must undergo cardiac surgery. The focus of this article is lay volunteer dyadic social-support for open-heart surgery patients. The authors describe such a program operating in Halifax, Nova Scotia, designed to link volunteers who have successfully recovered from open-heart surgery with those individuals about to undergo similar surgery. Comparisons are also made with parallel support programs in Canada and the United States. Thus far, only crude measurements of the effectiveness of this particular social-support intervention are available. The dyadic social-support that volunteers offer cardiac surgery patients seems to be effective as evidenced by the information discussed in this paper.
History, physical examination, and bone scintigraphy were used to diagnose central and/or third tarsal bone trauma in 3 acutely lame horses. In all 3 cases, the results of initial radiographic examination were negative. Bone scintigraphy revealed focal, intense radioisotope uptake at the level of the distal tarsal bones in the 3 horses. Radiographs obtained 4 weeks after injury in one horse demonstrated a slab fracture of the central tarsal bone. Conservative management of the tarsal bone disease resulted in acceptable return to function in all 3 horses.
A 3-month-old Quarter Horse filly stepped on a fence staple and developed navicular bone osteomyelitis of the right hindfoot. A 1.5-cm spherical portion of medullary cavity containing purulent material was debrided and flushed with 0.9% NaCl solution. Cancellous bone was collected from a caudal sternebra and placed into the defect. The solar defect had filled with granulation tissue and was epithelialized 6 weeks after surgery. At 6-month follow-up evaluation, the navicular bone defect had healed and the foal was sound on the limb. Cancellous bone grafting may have merit for the treatment of navicular bone osteomyelitis in the horse.
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The histologic and histochemical features of palatine muscles from 53 horses were studied; 25 of the horses were racehorses that had upper airway obstruction associated with dorsal displacement of the soft palate and 28 of the horses did not have any respiratory disorders and served as controls. Pathologic features observed included myonecrosis, phagocytosis, mononuclear cell infiltration of perimysial connective tissue, alkaline phosphatase-positive myofibers, and myofibers with cytoarchitectural changes that included irregular staining of the intermyofibrillar sarcoplasm and sarcoplasmic masses. These histopathologic features were judged to be indicative of myositis. Those features were found in both control horses and horses with dorsal displacement of the soft palate; however, their prevalence was higher in horses with dorsal displacement of the soft palate. For the control horses as well as the horses with dorsal displacement of the soft palate, the inflammatory changes were more prevalent in older horses. The finding of myositis suggests that palatal muscle weakness may contribute to the development of dorsal displacement of the soft palate; however, the myositis might have been secondary to trauma associated with displacement of the soft palate. We could not distinguish between these 2 possibilities. A large number of horses with dorsal displacement of the soft palate also had concurrent pharyngeal lymphoid hyperplasia. Extension of the mucosal inflammatory changes associated with pharyngeal lymphoid hyperplasia into the underlying palatine muscle might have accounted for the myositis.
A lateral radiograph of the pharyngeal region provides a technique for identifying pharyngeal disorders, including entrapment of the epiglottic cartilage and dorsal displacement of the soft palate. Epiglottic cartilage length, predicted from radiographs by measurement from the body of the thyroid cartilage to the tip of the epiglottis (thyroepiglottic length), was well correlated to actual length at postmortem examination (r2 = 0.98). Thyroepiglottic length, corrected for magnification, was 8.76 +/- 0.44 cm in 24 healthy Thoroughbreds. Nine Thoroughbreds with entrapment of the epiglottic cartilage and 6 with dorsal displacement of the soft palate had significantly short thyroepiglottic lengths--6.59 +/- 0.33 cm and 6.43 +/- 0.40 cm, respectively. The nasopharyngeal diameter of the Thoroughbreds with dorsal displacement of the soft palate was significantly less than the nasopharyngeal diameter of healthy Thoroughbreds. There was no significant difference between healthy and abnormal Thoroughbreds for pharyngoepiglottic, laryngeal, or tracheal measurements as determined from the lateral radiographs. The head should be placed in a normal resting position to obtain the pharyngeal radiograph. Maximum dorsiflexion of the head significantly increased the pharyngoepiglottic distance, whereas maximum ventriflexion significantly decreased this distance. The nasopharyngeal diameter during dorsiflexion was significantly greater than during ventriflexion. This investigation documented that a lateral pharyngeal radiograph provides important diagnostic information for evaluating suspected pharyngeal disorders in Thoroughbreds with airway obstruction of the cranial part of the respiratory tract.
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Uterine torsion was diagnosed in 26 mares of various breeds. The mean duration of gestation was 9.6 months. The most common clinical history was intermittent unresponsive colic of varying duration. Diagnosis of uterine torsion was confirmed by rectal palpation, and surgical correction was achieved in most cases by standing flank laparotomy and manual repositioning of the gravid uterus. Recumbent laparotomy was used only if the mare was intractable, the uterus was ruptured, or hysterotomy was indicated. Of 20 foals determined to be alive during surgery, 14 (70%) were subsequently born alive.
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Subchondral lesions were identified in the distal palmar region of the third metacarpus in 21 fetlock joints of 15 Thoroughbred horses. The lesions were more commonly identified on the lateromedial and flexed lateral projection, with the flexed lateral projection permitting optimal visualization of the lesion. Lesions appeared as poorly marginated, radiolucent defects and were located at the level of the base of the proximal sesamoid bones. The shape and distribution of the radiolucent defects were: crescent, 4; flattened, 4; shallow concavity, 5; deep concavity, 3; oval, 3; and circular, 2. Secondary joint disease was commonly identified in joints with these lesions and was more severe when the lesions increased in size and were irregular at the subchondral bony surface. Three horses with the palmar lesions were rested and re-examined after 16, 40, or 56 weeks. The lesions appeared smaller and less distinct on a subsequent examination for 2 horses, but the degree of secondary joint disease had increased in all 3 horses. Identification of palmar lesions when small seems important for the successful return of the Thoroughbred to racing soundness.