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1.
Pharmaceutical agents with potential for laminitis prevention have been identified. Many of these, including the MMP inhibitor marimastat, are impractical for systemic administration. This study compared local delivery of marimastat by regional limb perfusion (RLP) to systemic intravenous bolus dosing (SIVB), and established whether RLP results in local lamellar drug delivery. Six adult horses received 0.23 mg/kg of marimastat by RLP followed by 0.23 mg/kg marimastat by SIVB, with a 24‐h washout period. Lamellar ultrafiltration probes sampled lamellar interstitial fluid as lamellar ultrafiltrate (LUF). LUF and plasma marimastat concentrations (LUF[M] and P[M], respectively) were measured for 24 h after each treatment. Regional pharmacokinetic parameters were calculated using noncompartmental analyses. The LUF Cmax following RLP was 232 [34–457] times that following SIVB. LUF[M] after RLP were higher than those obtained after SIVB for 18 h (P < 0.03). Median LUF[M] were > IC90 of equine lamellar MMP‐2 and MMP‐9 for 9 h after tourniquet removal. RLP appeared superior to SIVB for lamellar marimastat delivery (higher LUF Cmax,, AUC and T > IC90 of lamellar MMPs). However, frequent dosing is necessary to achieve therapeutic lamellar concentrations. RLP could be used to investigate whether marimastat prevents experimentally induced laminitis. Further refinement of the technique and dosing interval is necessary before clinical application.  相似文献   

2.
Previous studies have shown that regional limb perfusion (RLP) using the palmar digital (PD) vein delivers therapeutic concentration of amikacin to the distal limb. Our hypothesis was that using the cephalic and saphenous veins for RLP will enable delivery of therapeutic concentrations of amikacin to the distal limb. Nineteen healthy horses participated in the study. The cephalic, saphenous, or PD vein was used to perfuse the limb with amikacin. Two grams of amikacin was used for RLP using the saphenous and the cephalic veins, and one gram was used in the PD vein. Synovial samples were collected from the metacarpo‐/metatarsophalangeal (MCP/MTP) joint, and blood samples were collected from the jugular vein. Maximum concentration (Cmax) of amikacin in the MCP/MTP joint using the cephalic and the saphenous vein was 277 and 363 mg/L, respectively. The amikacin concentrations achieved in the synovial fluid of the MCP/MTP joint in the current study were between 69 and 91 times the minimally inhibitory concentration of common susceptible bacterial pathogens causing orthopedic infections in horses. To conclude, this study shows that use of the proximal veins for RLP to treat distal limb infections is a viable alternative to using the palmar or plantar digital vein.  相似文献   

3.
Reasons for performing study: Mesenchymal stem cells (MSCs) are commonly injected intralesionally for treatment of soft tissue injuries in the horse. Alternative routes of administration would be beneficial for treatment of lesions that cannot be accessed directly or to limit needle‐induced iatrogenic damage to the surrounding tissue. Objectives: The purpose of our study was to evaluate MSC distribution after intra‐arterial (IA) and intravenous (IV) regional limb perfusions (RLP) using scintigraphy. We hypothesised that MSCs would persist in the distal limb after tourniquet removal and that both techniques would lead to diffuse MSC distribution. Methods: Six horses were used in the study. MSCs were labelled with hexamethyl propylene amine oxime (HMPAO) and technetium‐99m. RLP was performed through the median artery of one forelimb and the cephalic vein of the opposite limb under general anaesthesia. The tourniquet was left in place for 45 min. Scintigraphic images were obtained at 0, 45, 75 min, 6 h and 24 h post injection. Results: Distribution of labelled MSCs through the entire distal limb was achieved with all 6 IA RLP, but 3 out of 6 IV RLP showed poor or absent uptake distal to the metacarpus. Mesenchymal stem cell persistence was 39% (30–60%) and 28% (14–50%) (median [minimum–maximum]) at 6 h for IA and IV RLP, respectively. Severe arterial thrombosis occurred in one horse after IA RLP. Conclusions: Both IA and IV RLP of the distal limb result in MSC persistence in perfused tissues. The IA perfusion resulted in more reliable cell distribution to the pastern and foot area. Potential relevance: Regional limb perfusion of MSCs might be used in cases where intralesional injection is not possible or in order to avoid iatrogenic needle damage. Further work is needed to assess the safety of IA RLP before its clinical use.  相似文献   

4.
Regional limb perfusion (RLP) significantly decreases morbidity and mortality associated with distal limb injuries in horses. There is an urgent need for finding additional effective antimicrobial drugs for use in RLP. In this study, we tested the pharmacokinetics (PK) of chloramphenicol in RLP. Eight horses participated in the study, which was approved by the University Animal Care and Use Committee. The cephalic and the saphenous veins were used to perfuse the limbs. Synovial samples were collected from the metacarpo/metatarsophalangeal (MCP/MTP) joint. The Friedman Test was applied for assessing change in PK concentration over time, for all time points. The Wilcoxon Signed Ranks Test was used to test the difference between PK concentration in joint & serum as well as concentration in joint vs. MIC. The comparison of measurements between measurements taken on hind vs. front legs was carried out using the Mann–Whitney Test. A P‐value of 5% or less was considered statistically significant. After RLP, the concentration of chloramphenicol in the synovial fluid of the MCP/MTP joint using either the cephalic or the saphenous vein was initially far above the minimal inhibitory concentration (MIC) of most susceptible pathogens and remained above the MIC for approximately 6 h. The results indicate that performing RLP using the cephalic and saphenous veins enables reaching concentrations of chloramphenicol in the MCP/MTP joint that are well above the MIC of most susceptible pathogens. The chloramphenicol concentrations achieved in the synovial fluid of the MCP/MTP joint in the current study were between 1.5 (MTP) and 7 (MCP) times the MIC of MRSA in horses. These results are encouraging since MRSA infections are becoming far more common, causing considerable morbidity. To the best of our knowledge, this is the first study to evaluate the pharmacokinetics of chloramphenicol following RLP in the horse and the results are positive.  相似文献   

5.
There are no reported studies evaluating the use of erythromycin for regional limb perfusion (RLP) in horses. Our hypothesis was that using the cephalic and saphenous veins for RLP will enable delivery of therapeutic concentrations of erythromycin to the distal limb. Nineteen healthy horses participated in the study. The cephalic, saphenous or palmar digital (PD) vein was used to perfuse the limb with erythromycin. Synovial samples were collected from the metacarpo/metatarso‐phalangeal (MCP/MTP) joint and blood samples were collected from the jugular vein. Maximum concentration (Cmax) of erythromycin in the MCP joint using the cephalic vein was 113 mg/L. The Cmax of erythromycin in the MTP joint using the saphenous vein was 38 mg/L. Erythromycin administered using the PD vein was not detectable in the MCP/MTP joint of four of six horses. Concentrations of erythromycin achieved in the synovial fluid of the MCP/MTP joint were between 152 and 452 times the minimal inhibitory concentration (MIC) for Rhodococcus equi (R. equi). In conclusion, the results indicate that when using the saphenous or cephalic veins for RLP, therapeutic concentrations of erythromycin in the MTP/MTP joint can be consistently reached.  相似文献   

6.
Over the last decades the use of antimicrobial regional limb perfusion (A-RLP) has increased and A-RLP is nowadays commonly used to treat orthopaedic infections by many equine practitioners. There have been a large number of studies published on the use of A-RLP, many of which describe regional drug pharmacokinetics and clinical safety of the administration of different antimicrobials by A-RLP. A limited number of studies describe the clinical use of A-RLP as prophylactic or therapeutic treatment. However, despite being in use for 30 years there is still limited evidence about the efficacy of A-RLP as a means to prevent and treat orthopaedic infections in horses.  相似文献   

7.
ObjectivesTo describe the anatomy and approaches reported for peripheral nerve blockade (PNB) of the pelvic limb in dogs and cats and to consider the role of PNB in relation to the extradural technique.Databases usedThis review was conducted using the terms ‘nerve block’, ‘extradural’ ‘dog’ and ‘cat’ entered into Pubmed and Google. Results were filtered manually to narrow the field to pelvic limb nerve blocks. The reference lists of retrieved papers were scrutinized to identify further studies for inclusion.ConclusionsSuccessful PNB techniques require thorough anatomical knowledge for the establishment of reliable landmarks, puncture sites, the direction and depth of needle insertion, and relevant structures to be avoided. To date, clinical evaluations have been made in subjects undergoing stifle surgery where the sciatic nerve has been blocked in combination with various approaches to the femoral nerve. Currently the bulk of literature examines new approaches to these nerves and each of these is described. To date there are no veterinary studies directly comparing one approach versus another, and therefore one is unable to draw conclusions of superiority. The role of PNB’s versus the extradural technique is discussed.  相似文献   

8.
The objectives of this study were to determine whether thermal quantitative sensory testing (QST) can be performed in client-owned dogs, is repeatable and whether QST differs between normal dogs and dogs with hind limb osteoarthritis (OA). This clinical, prospective, observational study used clinically normal dogs (n = 23) and dogs with OA-associated hind limb pain (n = 9). Thermal QST was performed in standing dogs using a high-powered light source delivered by a previously validated system. Dogs were tested on two occasions, 2 weeks apart. Five tests were performed on each hind limb at each time point. Repeated measures analysis of variance was used to evaluate the effects of leg, time point and OA/normal status on thermal threshold latencies (TTL). Additionally, paired t tests were used to compare the TTL of left and right limbs within groups and between time points.Thermal thresholds were successfully measured in 32 client-owned dogs without prior training. TTL were significantly different between normal and OA dogs (P = 0.012). There was no difference between limbs (P = 0.744) or time periods (P = 0.572), when analyzed by repeated measures analysis of variance, and no interactions between group and limb, visit and limb, or visit and group. In conclusion, thermal thresholds can be measured in client owned dogs with no prior training and are repeatable from week to week. Further data are required to determine if OA results in thermal hypoalgesia as measured at the distal hind limb and whether this is an indication of central sensitization.  相似文献   

9.
A retrospective study of 63 horses diagnosed with limb cellulitis between 1994 and 2005 was conducted. They all had an acute onset of painful, generalised limb swelling, and a clinical diagnosis of limb cellulitis was made by the attending clinician. None of the horses had more than one limb affected. Hindlimbs were significantly more often affected than the forelimbs (P<0.05). Thoroughbreds were significantly over-represented compared with the general distribution of breeds examined at the hospital. Blunt limb trauma, limb surgery and limb injections were associated with the cellulitis in most of the horses, but no plausible cause could be determined in 27 (43 per cent) of the cases. Staphylococcus aureus and Streptococcus species were frequently isolated, although mixed bacterial infections were also common. All the horses were treated with broad spectrum antimicrobials and non-steroidal anti-inflammatory agents, and ultrasound-guided surgical drainage was also applied in 14 cases. Fifty-six of the 63 horses (89 per cent) were discharged from the hospital. Laminitis affecting the contralateral limb was the most common reason for the euthanasia of the other seven horses.  相似文献   

10.
OBJECTIVE: To describe the surgical technique and clinical results of treatment for forelimb angular limb deformities, secondary to premature distal radial or ulnar physeal closure, by using T-plate fixation of a distal radial closing wedge osteotomy in 18 dogs. STUDY DESIGN: Retrospective clinical study. SAMPLE POPULATION: 18 client-owned dogs. METHODS: The medical records of 18 dogs that underwent a distal radial closing wedge osteotomy with T-plate fixation for correction of a forelimb angular limb deformity were reviewed. Small pins (Kirschner wires) were used to obtain the appropriate alignment of the antebrachiocarpal and elbow joints and proper limb orientation. In-hospital follow-up evaluation was obtained at the time fracture healing was observed radiographically. Further long-term follow-up was obtained by owner interview. RESULTS: Osteotomy sites were radiographically healed within 4 to 12 weeks (mean, 8 weeks) after surgery in the 14 dogs that returned for in-hospital follow-up. Limb function was graded as good or excellent in all dogs. Long-term follow-up by owner interview rated limb function and cosmetic appearance as good to excellent in all dogs. Plate removal was necessary in one dog 7 months after surgery because of osteopenia in the radius. CONCLUSION: This surgical technique was considered successful in the treatment of angular limb deformities in all dogs. A good to excellent prognosis is to be expected with this technique, with minimal complications. CLINICAL RELEVANCE: The use of a T-plate for the correction of angular limb deformities has not been previously described in the literature. This technique permits accurate correction of the angular limb deformity and minimizes postoperative complications.  相似文献   

11.
Objective: To determine (1) if clinically useful concentrations of amikacin sulfate can be obtained in synovial fluid during regional limb perfusion (RLP) performed above the carpus in standing sedated horses and (2) to determine the efficacy of 3 tourniquet types (narrow rubber [NR], wide rubber [WR], pneumatic [PN]). Animals: Horses (n=9). Methods: Bilateral forelimb RLP with amikacin sulfate (2.5 g) were administered through the cephalic vein in standing sedated horses. Limbs were randomly assigned to the 3 tourniquet types (NR, WR, PN) applied above the carpus. Metacarpophalangeal synovial fluid was obtained 0.5 hour after perfusion. Amikacin concentration in the synovial fluid was detected using fluorescence polarization immunoassay. Results: Mean synovial concentrations of amikacin in the PN (mean 236 μg/mL; range 23–913 μg/mL) and WR (mean 64.2 μg/mL; range 7–315 μg/mL) were significantly higher (P=.000 and .032, respectively) than the NR tourniquet (mean 2.1 μg/mL; range 0.9–3.3 μg/mL). Conclusions: The PN tourniquet resulted in the highest synovial fluid amikacin concentrations in all horses, although administration with PN and WR tourniquets achieved adequate amikacin concentrations. NR tourniquet is ineffective and should not be used for RLP above the carpus in the standing horse.  相似文献   

12.
In several veterinary institutions, adjustments of CT machines have been made that allow for imaging of the standing horse. The risk of general anesthesia is eliminated and the shorter scan completion time reduces cost to clients. The objective of this retrospective, analytical study was to evaluate the technique, imaging diagnoses, feasibility, and image artifacts of multi-slice helical CT of horses’ distal limbs acquired under standing sedation. The CT images of 250 horses of various breeds, aged 3–23 years, that underwent standing distal limb CT were evaluated. Three observers assessed the CT images for artifacts and inter-observer agreement was calculated. Eighty-six percent (95% confidence interval (CI), 81–90) of the scans were carried out on the forelimbs, while 14% (95% CI, 10–19) were of the hindlimbs. A total of 65% (95% CI, 59–71) of horses that underwent standing sedated CT had single imaging diagnoses. Seventy-one percent (95% CI, 65–77) of the cases had unilateral lesions, 27% (95% CI, 22–33) had bilateral lesions and 2% (95% CI, 1–4) had no diagnosed lesions. The average CT acquisition time was 17.5 minutes (range = 15–20). The average number of acquisitions per horse was 1.7 (median = 1; range = 1–4). There was good to excellent agreement between all three observers for the presence of motion artifact in the metacarpo/metatarsophalangeal joints, identification of marked beam hardening artifact, mild solar/ skin dirt, and photon starvation artifact (kappa 0.61-0.80). No complications were encountered. Standing examination of the distal limb achieved diagnostic image quality that was obtained with minimal acquisition attempts and in a timely manner.  相似文献   

13.
Numerous techniques for surgical correction of angular limb deformities in horses involving an osteotomy of the affected bone and stabilization with an internal fixation device have been described. However, because the osteotomy typically has to be performed at the level of the physis, leaving little bone between the physis and the nearest joint, stabilizing the osteotomy by use of internal fixation devices may be difficult. In horses with severe chronic angular limb deformities, the amount of soft-tissue contracture may make it impossible to correct the deformity during a single procedure without causing stretch injuries to the adjacent tendons and neurovascular structures. Adjustable external ring fixators incorporating hinged rods on 1 side of the limb and an angular motor assembly on the other may be useful for treatment of severe chronic angular limb deformities in younger equids, because they allow for gradual correction of the deformity.  相似文献   

14.
Regional limb perfusion is used to treat infections of the distal limb and can be performed using a peripheral vein or the intraosseous route; the peripheral vein is the preferred technique. Other distal limb entities of clinical importance include foot conformation problems, bruising, heel pain, navicular disease, degenerative joint disease, tendonitis and desmitis. Specific clinical problems of the distal limb seen in the foal and aged horse are frequently managed with good foot care.  相似文献   

15.
Regional limb perfusion involves administration of an antimicrobial solution into the vasculature of a selected portion of the limb that has been isolated from the systemic circulation by controlled application of a tourniquet. The technique provides high antimicrobial concentrations in the region of interest and greatly contributes to the elimination of infection.  相似文献   

16.
ObjectiveTo evaluate the analgesic effects of orally administered gabapentin on horses with chronic thoracic limb lameness.Study designRandomized, crossover design.AnimalsA total of 14 adult horses with chronic thoracic limb lameness.MethodsFollowing baseline measurement of lameness, horses were administered each of four treatments orally in grain: treatment G, gabapentin (20 mg kg–1) twice daily for 13 doses; treatment F, firocoxib (171 mg once, then 57 mg once daily for six doses); treatment GF, gabapentin and firocoxib at previously stated doses and frequencies; or treatment C, grain only as a control. Treatments were administered in a randomized, crossover design, separated by 2 weeks. Subjective lameness score (SLS), inertial sensor vector sum (VS) calculations, peak vertical ground reaction force (PVGRF) measurements and vertical impulse (VI) calculations were determined immediately prior to each initial treatment dose and 2–4 hours after the final treatment dose for each treatment. Mean change in SLS, VS, PVGRF and VI for each treatment were compared among treatments.ResultsThe rank change in SLS of treatment GF was significantly greater than that of treatments C (p = 0.01) and G (p = 0.01) but not of treatment F (p = 0.08). No differences in VS (p = 0.4), PVGRF (p = 0.4) or VI (p = 0.1) were observed among treatments.Conclusions and clinical relevanceGabapentin, as administered here, did not improve subjective or objective measures of lameness in horses with chronic thoracic limb musculoskeletal pain. Although subjective evaluation identified an improvement in lameness with treatment GF, it was not different from that observed with treatment F. Higher oral dosing and longer treatment regimens of gabapentin may be indicated for the treatment of chronic musculoskeletal pain in horses.  相似文献   

17.
OBJECTIVE: To study the pharmacokinetics of vancomycin in plasma obtained from the medullary sinusoids of the proximal phalanx (P1) after intravenous (IV) and intraosseous (IO) regional limb perfusion (RLP). STUDY DESIGN: Experimental study. ANIMALS: Twelve horses. METHODS: IV and IO RLP were performed in 2 groups (n = 6) of horses. Vancomycin hydrochloride (300 mg in 60 mL 0.9% NaCl) was randomly infused in 1 front limb, with the contralateral limb as control (60 mL 0.9% NaCl). A hole was drilled in the lateral cortex of P1, and blood samples from the medullary sinusoids of P1 were collected before infusion, and 15, 30, 45, 65, and 90 minutes after beginning infusion. Samples were centrifuged and plasma vancomycin concentrations determined. Vancomycin concentrations were compared over time and between routes using a 2-way repeated measures ANOVA. Pharmacokinetic variables were compared with a Kolmogorov-Smirnov test. Significance was set at P<.05. RESULTS: No vancomycin-induced clinical side effects such as lameness or swelling were observed. Both techniques, IV and IO, produced high vancomycin concentrations in the sinusoidal plasma of the P1, which remained above the minimum inhibitory concentration value for methicillin-resistant Staphylococcus aureus (MRSA) during the 90 minutes study. Concentrations and pharmacokinetic variables were not significantly different comparing both routes. CONCLUSIONS: IV and IO routes produced similar antimicrobial perfusion of the medullary cavity of P1. CLINICAL RELEVANCE: Either IV or IO routes for perfusion are likely to be equally selected when planning RLP with vancomycin.  相似文献   

18.
Surgical management of postamputation orthopedic disease (PAOD) in canine amputees has rarely been documented, and no reports describing outcome of stifle surgery in canine amputees are available. The objective of this multisite retrospective case series was to describe cases and evaluate satisfaction with and outcome of postamputation orthopedic surgery in canine amputees. Data was obtained through medical records and owner survey responses; data included signalment, amputation cause, diagnosis, surgical treatment, timeframes, and outcome assessment. Outcome was categorized as acceptable or unacceptable, and complications were classified as catastrophic, major, or minor. Eleven thoracic limb amputees and 6 pelvic limb amputees with surgically treated PAOD were identified. Surgically treated PAOD was reported at a median of 9.7 months (range 0.5-110 months) after amputation. All 17 amputees were treated for pelvic limb disease, predominantly for cranial cruciate ligament disease that occurred in 11 of 17 dogs. Major complications following orthopedic surgeries performed in 3 thoracic limb amputees consisted of infection (n?=?2) and uncontrolled pain (n?=?1). No major complications were reported following orthopedic surgeries performed in pelvic limb amputees. Acceptable mid-to-long-term outcome was achieved in 16 of the 17 canine amputees. Surgical treatment of pelvic limb disease did not appear to be associated with a high number of major complications in this case series. These findings suggest that orthopedic surgery, specifically stifle surgery, in canine amputees might be considered a feasible treatment option. Although there are inherent methodological limitations of retrospective studies and owner surveys, our case series provides new information that might help guide surgical treatment decisions in canine amputees suffering from orthopedic disease. Prospective studies using objective outcome measures evaluating surgical management of PAOD are necessary to confirm the provided information.  相似文献   

19.
Distal limb reconstruction is complicated by the paucity of local tissues and the frequent association of orthopedic injury with cutaneous loss. Second-intention healing or skin stretching techniques are used for wounds involving less than a 30% circumference of the limb. Skin grafts are recommended for reconstruction of larger superficial wounds after establishing a bed of granulation tissue or for immediate reconstruction of clean wounds overlying healthy muscle. Wounds complicated by orthopedic injury benefit from early reconstruction using vascularized tis-sue. Weight-bearing surface reconstruction and management of partial amputation injuries are functionally difficult because of the environmental stress placed on the paw pads. Paw pad grafts, paw pad transposition techniques, centralization of digits, and microvascular free tissue trans-fer of paw pads can be considered for weight-bearing surface reconstruction. Definitive guidelines describing when each of these techniques should be used have not been established.  相似文献   

20.
The objective of the present study was to model in 3D the detailed morphometric features of the thoracic and pelvic limb bones of the gazelle (Gazella subgutturosa), whose natural habitat is only in the Sanliurfa province, by using multidetector computerized tomography (MDCT) images. Materials from 14 (7 male and 7 female) dead gazelles were collected from the Harran University Veterinary Medicine Faculty clinics during or after treatment. MDCT images of the gazelles were taken and saved as DICOM (Digital Imaging and Communications in Medicine) files. MIMICS 20.1 software was used to generate a 3D reconstruction of the data, and morphological and morphometrical evaluation was performed. In respect of morphological features, the combined metacarpus (Mc) III and metacarpus Mc IV were the main weight-bearing metacarpal bone, while Mc II and Mc V were rudimentary. On the femur, the lateral condyle was bigger than the medial condyle at the caudodistal end and the medial wing of the trochlea femoris was larger than the lateral. As with the thoracic limb, the combined metatarsus (Mt) III and metatarsus Mt IV were the main weight-bearing metacarpal bone and they displayed a synostosis structure. There was no secondary metatarsus in the gazelles’ pelvic limb. Based on digital measurements, the tibia was the longest bone of the gazelles’ skeletal system, and there was a statistically significant sexual dimorphism throughout the skeleton at the levels of p < .05, p < .01 and p < .001. As a result, the present study's findings are useful as reference data for further studies on anatomy, surgery and archaezoology, while also being useful for classifying species and for forensic sciences.  相似文献   

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