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Biomedical subjects

E A Scott

Publications and source records attributed to E A Scott.

At least 19 recordsLinked to original sources
PubMed1992

Fate and effect of autogenous osteochondral fragments implanted in the middle carpal joint of horses.

Four autogenous osteochondral fragments removed from the lateral trochlear ridge of the talus were arthroscopically placed as loose bodies in a randomly selected middle carpal joint in each of 10 horses. The contralateral middle carpal joint, subjected to a sham procedure, served as control. Postoperative treatment was consistent with that for clinical arthroscopic patients. Lameness evaluation, radiographic examination, carpal circumference measurement, and synovial fluid analysis were performed before and at scheduled intervals after surgery. After a 2-month confinement, horses were subjected to an increasing level of exercise. Horses were euthanatized at intervals through 6 months. Gross and microscopic evaluations were performed on remaining fragments, articular cartilage, and synovial membrane of each middle carpal joint. Increased joint circumference, effusion, lameness, and degenerative joint disease distinguished implanted from control joints over the 6-month period. Implanted joints were characterized by grooved, excoriated cartilage surfaces, and synovium that was thick, erythematous, and irregular. At 4 weeks, implants were found to have adhered to synovium at their subchondral bone surface. The bone within fragments was undergoing necrosis, while cartilage was preserved. At 8 weeks, fragments were radiographically inapparent, grossly evident as pale plaques on the synovial surface, and composed of dense fibrous connective tissue. Synovial membrane specimens from implanted joints had inflammatory change characterized by mononuclear cell infiltration 2 months after implantation. Physical damage was apparent within articular cartilage of implanted joints at 2 months, and was significant (P less than 0.05) at 6 months after surgery. Chondrocyte degenerative change was significant (P less than 0.05) at 6 months after surgery. Focal reduction in safranin-O uptake was observed in cartilage layers adjacent to physical defects. Osteochondral loose bodies of the size implanted in the middle carpal joint of horses in this study were resorbed by the synovium within 2 months. Synovitis and significant articular cartilage damage were associated with the implanted fragments. Regardless of origin, free osteochondral fragments within the middle carpal joint should be removed, and methods to prevent residual postoperative debris should be implemented to reduce potential for articular pathologic change.

Animals↗
PubMed1992

Appropriateness of cholecystectomy: the public and private sectors compared.

OBJECTIVE: To investigate the appropriateness of cholecystectomies undertaken in the public and private health sectors. DESIGN: Retrospective case note review using the findings of two consensus panels. SETTING: 35 consultant surgeons working for North West Thames Regional Health Authority and in the private sector. PATIENTS: 269 patients undergoing cholecystectomy during the study period, of whom 17 were excluded because there was insufficient information available. MAIN OUTCOME MEASURES: Appropriateness ratings as assessed by two consensus panels, one composed of surgeons and one mixed, containing doctors from different specialties. RESULTS: The mixed panel would have rated 41 per cent of cases appropriate, less than 1 per cent equivocal and 30 per cent inappropriate. The remaining 29 per cent had indications about which the panel did not reach agreement. The surgical panel would have rated 52 per cent appropriate, 3 per cent equivocal and 2 per cent inappropriate. The remaining 44 per cent had indications about which the panel did not reach agreement. Most of the patients who would have been rated inappropriate had vague symptoms only. There were no significant differences between the NHS and private patients as regards their appropriateness. NHS patients were more likely to have more than one ultrasound and to be operated on as an emergency. CONCLUSIONS: An appreciable proportion of patients undergo cholecystectomy for indications which were deemed inappropriate by a mixed panel, but not a surgical panel. Variation in clinical judgement is an important factor in the decision to operate--44 per cent of cases had indications, the appropriateness of which the surgical panel were undecided about. There were no significant differences between NHS and private patients as regards the appropriateness of their indications. These findings need to be confirmed by further studies comparing the public and private sectors.

Adult↗
PubMed1991

Subchondral bone cysts with fractures of the extensor processes in a horse.

Probable cause of fracture in a Paint gelding was a congenital bone defect involving the extensor process area of the right and left forelimb distal phalanges. Radiographically and histologically, subchondral bone cysts at the fracture lines were suspected. These cysts were thought to have developed in association with abnormal ossification centers at the extensor process areas of the third phalanx. Partial avulsion of weak extensor processes would then occur from natural forces exerted on these weakened bony prominences via the common digital extensor tendon. Support for osteochondrosis as a cause of this bone cyst formation was seen in histologic examination of fragments removed. Within the bony trabeculae, a dysplastic focus of cartilage with mineralized plaques and osseous tissues was observed. Findings supported a diagnosis of osteochondrosis, to the extent that the disease is presently understood in horses. Surgical correction by fragment removal was performed to circumvent progression of degenerative joint disease, which was evident as partial cartilage erosion of the distal dorsal articular surface of the second phalanx and fracture fragments. Recovery from surgery was rapid, and several months after surgery, the horse was sound for pleasure riding.

Animals↗
PubMed1991

When does consensus exist in expert panels?

Increasingly, expert panels are being used to determine whether or not a consensus exists about criteria of good practice. It is, however, unclear how sensitive the panels' conclusions are to changes in the definitions of agreement and disagreement used. To explore this, two expert panels were established to assess the appropriate indications for cholecystectomy. Analyses of the results showed that the level of agreement depended on whether or not the views of outliers were included or eliminated. Exclusion of outliers increased the proportion of appropriate indications from about 40 per cent to 60 per cent. In contrast, the proportion of indications felt to be inappropriate was dependent on how strict the definitions employed were. Given that the principal purpose of expert panels is to inform quality assurance activities, the higher levels of agreement and disagreement achieved by eliminating outliers and employing more relaxed definitions are to be favoured.

Cholecystectomy↗
PubMed1991

Appropriateness of cholecystectomy in the United Kingdom--a consensus panel approach.

A consensus development approach was used to assess the extent to which doctors in the UK agreed about the appropriate indications for cholecystectomy. Two panels, one composed entirely of surgeons and one containing a mix of relevant specialists, were asked to rate a series of possible indications. A consensus was achieved for 61% (surgical panel) and 67% (mixed panel) of indications considered. The surgical panel considered more indications as being appropriate for cholecystectomy (29% v 13%) and fewer indications as being inappropriate (27% v 50%) than the mixed panel. For between one third and a half of all indications, the panels were unable to reach agreement, partly as a result of differences in views as to the role of endoscopic sphincterotomy.

Aged↗
PubMed1991

Steady-state response characteristics of a pulse oximeter on equine intestine.

The steady-state response characteristics of a pulse oximeter were evaluated on intestinal segments of seven clinically normal halothane-anesthetized horses. Arterial oxygen tension greater than 200 mm of Hg, end tidal carbon dioxide from 30 to 35 mm of Hg, and systemic mean arterial pressure greater than 70 mm of Hg were maintained throughout the recording periods. Values for percentage of pulse oximeter oxygen saturation, pulsatile blood flow, and percentage of signal strength were recorded from jejunum, ileum, cecum, left ventral colon, left dorsal colon, and descending colon. Probe placement on intestinal segments was recorded as over or not over visible subserosal or transmural vessels. There was no significant difference between median values on the basis of vessel codes for pulse oximeter oxygen saturations, pulsatile flow, and signal strength. Median values recorded for pulse oximeter oxygen saturation were 93% from jejunum and ileum and 95% from cecum, left ventral colon, left dorsal colon, and descending colon; median values for pulsatile flow were 576 from jejunum, 560 from ileum, 560 from cecum, 574 from left ventral colon, 578 from left dorsal colon, and 560 from descending colon; median values for signal strength were 50% from jejunum, 67.5% from ileum, 60% from cecum, 75% from left ventral colon, 50% from left dorsal colon, and 52.5% from descending colon. Median values obtained from each anatomic location were not significantly different for pulsatile flow or signal strength. Median pulse oximetry oxygen values recorded from jejunum and ileum were significantly lower than values obtained from other intestinal segments.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Low immunisation rates: fact or fiction?

The uptake rate for primary immunisation against diphtheria in 1987 in the east part of Riverside District Health Authority was 61% for children aged two. A retrospective survey was undertaken of the immunisation records of all children aged two recorded on the Child Health System as not fully immunised: 46% had been immunised; 18.1% had moved out of the district; 15.6% of the children could not be traced; in 13.6% of records, there was no reference to immunisation; and only 2.5% of children were definitely not immunised. Large numbers of omissions were found in the data held on the Child Health System. The reasons for this are discussed and recommendations made for improving the quality of the data held.

Child↗
PubMed1989

Monorchidism in the horse.

Six horses with monorchidism, identified at surgery for cryptorchidectomy, are reported. All six presented with a single scrotal testis. Following surgical removal of one testis, they were either hormonally, anatomically or behaviourally determined to be geldings. Three other horses reported in the literature are reviewed. Of these nine cases of monorchidism, eight were thought to be caused by testicular degeneration and one by testicular agenesis. The vaginal process was present in all of the former and absent in the latter. The left side was involved in five of these eight horses. In seven, the epididymis was absent and, in the remaining two, only the epididymal tail was present. The condition was thought to be congenital in the six horses in this series. A surgical approach to identify accurately monorchid horses is described.

Animals↗
PubMed1988

Permanent tracheostomy in Equidae: 47 cases (1981-1986).

Between 1981 and 1986, permanent tracheostomy was performed in 46 ponies and 1 adult Quarter Horse. Tracheostomies of 19 ponies and the horse were examined in June 1986 and evaluated for vertical length of stomal orifice (mean = 25.0 +/- 4.7 mm in the ponies and 55 mm in the horse), degree of tracheal obstruction (0/20), regrowth and apposition of epidermis (3/20), and whether or not stomal airflow occurred with nasal occlusion (20/20). In addition, the animals were evaluated to determine whether dyspnea developed during exercise. Records of 27 ponies were evaluated. Six of the 27 were not dyspneic with exercise at their last routine physical examination. Twenty-one ponies had died or had been euthanatized, but only 5 of these deaths were attributed to complications associated with the respiratory tract; 3 ponies had collapsing tracheas and 2 had chronic obstructive pulmonary disease. The permanent tracheostomy technique provided a functional and cosmetic airway and was associated with a low rate of complications.

Animals↗
PubMed1987

Dental dolorimetry for the evaluation of an analgesic agent in the horse.

A monopolar electrode was implanted surgically in the canine tooth dentine layer to evaluate pain threshold responses of horses. A constant-current stimulator was used to deliver a known electrical current to the tooth pulp nerve. A single stimulus of 2-ms duration, repeated at greater than or equal to 20-s intervals, was used to elicit a head lift response. The lowest current level that produced 3 positive head lift responses was recorded as the pain threshold of the horse. The testing technique, dental dolorimetry, was easily performed. Tooth pulp pain thresholds (TPPT) were established on 8 nonmedicated adult male horses. Electrodes were nonreactive and remained functional for up to 98 days. Base-line TPPT values were consistent with repeated measurements on the same day and measurements on subsequent test days. The quantity of electrical current necessary to elicit the TPPT was increased after administration of xylazine HCl as a test analgesic.

Analgesics↗
PubMed1986

Failure of the tourniquet-twitch test as a diagnostic or screening test for malignant hyperthermia.

We have performed the tourniquet-twitch test of Roberts and Ryan in normal and in malignant hyperthermia (MH) patients and relatives. This test measures the ratio of electrically induced thumb twitches noted after 10 min of ischemia with those noted immediately prior to the ischemia. We found no significant differences in this ratio between normal subjects and those who have had MH reactions, or relatives of such individuals. Furthermore, we have observed no significant differences in tourniquet-twitch ratios between those with normal caffeine-halothane contractures and persons with caffeine-halothane contractures tests positive for MH. These findings do not agree with those of Roberts and Ryan, who reported that tourniquet-twitch ratios were higher in MH patients than in normal patients. We have, however, determined that subjects with tourniquet-twitch ratios greater than or equal to 1.8 are substantially younger than those with tourniquet-twitch ratios less than or equal to 1.0. Therefore we do not believe that the tourniquet-twitch test is useful as a diagnostic, or even as a screening test for MH.

Humans↗
PubMed1986

Failure of the platelet-halothane nucleotide depletion test as a diagnostic or screening test for malignant hyperthermia.

A platelet-halothane nucleotide or bioassay test has been suggested as an accurate means for diagnosis of malignant hyperthermia (MH). For the last three years we performed this test in all patients at risk for MH and in all normal control patients undergoing skeletal muscle biopsy in our diagnostic unit. The reliability of the platelet-halothane nucleotide test has been assessed on the basis of the presence or absence of a previous MH reaction and degree of relationship of relatives to those who have had reactions, and on the basis of caffeine-halothane contracture test values (positive or negative for MH). We have found no significant difference in platelet-halothane nucleotide test values in malignant hyperthermia susceptible (MHS) patients or relatives of MHS patients and normal controls, and no relationship between the nucleotide test and caffeine-halothane contracture test results. We conclude that the platelet-halothane nucleotide test is not of assistance in the diagnosis of or in the screening for MH.

Blood Platelets↗
PubMed1986

Effect of laryngeal hemiplegia and laryngoplasty on airway flow mechanics in exercising horses.

The effect of left laryngeal hemiplegia on airway flow mechanics in 5 exercising horses was examined, and the efficacy of surgical repair by prosthetic laryngoplasty was evaluated. Measurements of the upper airway flow mechanics were made with horses on a treadmill (incline 6.38 degrees) while standing (period A); walking at 1.3 m/s (period B); trotting at 2.6 m/s (period C); trotting at 4.3 m/s (period D); and standing after exercise (period E). Experiments were done on healthy horses before any surgical manipulation (control), at 10 days after left recurrent laryngeal neurectomy, and at least 14 days after prosthetic larynogoplasty. Increasing treadmill speed from period A to period D progressively increased heart rate, respiratory frequency, peak inspiratory flow, and peak expiratory flow, but inspiratory resistance and expiratory resistance remained unchanged. Neither left recurrent laryngeal neutrectomy nor prosthetic laryngoplasty affected heart rate, respiratory frequency, peak expiratory flow, or expiratory resistance when compared with those values at the control measurement periods. Left recurrent laryngeal neurectomy resulted in inspiratory flow limitation at peak inspiratory flow of approximately 25 L/s, and increased inspiratory resistance at periods D and E. Subsequent prosthetic laryngoplasty alleviated the flow limitation and reduced inspiratory resistance at measurement periods D and E.

Animals↗
PubMed1985

Chronic intestinal intussusception in two horses.

In 2 cases of chronic intestinal intussusception in horses, one involved jejunum and the other, ileum. The only clinical signs observed were intermittent colic. Surgery was performed on both horses, with successful outcomes.

Animals↗
PubMed1979

Repair of incisional hernias in the horse.

Incisional abdominal hernias in three horses were repaired, using synthetic mesh with a fascial flap overlay. The repair of large ventral abdominal hernias of horses can be accomplished by using synthetic mesh that is sutured across the defect. This material can be placed subperitoneally, retroperitoneal but subfascial, retrofascial and subfascial, or retroperitoneal but subfascial with a fascial overlay. Advantages of using this material are that it can be used for repair of large hernias, it is easy to apply, it is strong and flexible, and it is less likely to be rejected, when compared with other synthetic materials.

Abdomen↗
PubMed1979

A review of third phalanx fractures in the horse: sixty-five cases.

Sixty-five cases of third phalanx (P3) fracture were retrieved from 20,638 case records at Michigan State University's Veterinary Clinical Center between Feb 1, 1964 and July 1, 1977. The fractures were classified by anatomic location, using a numbering system. Data from case records indicated the most common P3 fracture involved the articular surface of the coffin joint (53 of 65 cases; 81.5%). The greatest occurrence of P3 fracture was in Standardbreds (31 of 65 cases). Thirty-three of the 65 fractures were in geldings of all breeds; 57 of the cases were distributed among racing horses of four breeds; and the mean ages at time of fracture for these groups were 4.9 to 5.3 years. The most common cause of P3 fracture was racing injury. Of 57 P3 fractures of the forelimb, 51 (89.5%) involved the lateral aspect of the left limb or medial aspect of the right limb--the part of each foot supporting most of the horse's weight in turns, while racing counterclockwise. Methods and response of treatment were evaluated by questionnaires obtained from 31 of the 65 owners. This questionnaire solicited information from owners and trainers as to: (1) cause, (2) treatment, (3) outcome, and (4) the use of the horse. Results were tabulated for: (1) questionnaire information obtained, (2) a classification system for P3 fractures, based on the anatomic location of the fracture, and (3) distribution of fractures between limbs and position (medial vs lateral) within limbs.

Animals↗