Sleep protocol: a research-based practice change.
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Biomedical subjects
Publications and source records attributed to G B Edwards.
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A centrifugation/flotation technique for the identification of equine tapeworm eggs is described. It was validated by using faeces samples from 80 horses of known tapeworm status, and had a sensitivity of 61 per cent and a specificity of 98 per cent. The exclusion of false negative results in animals with less than 20 tapeworms increased the sensitivity to 92 per cent. No significant correlation was found between the number of eggs observed and the number of tapeworms present in the horses.
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Several imaging techniques were used to diagnose hypoplasia of the soft palate in a horse. The absence of the caudal soft palate, hypertrophied lymphoid tissue and the formation of a pseudouvula were observed endoscopically. Plain and contrast radiography were used to demonstrate a soft palate remnant and to identify structures rostral to the epiglottis. Retrograde endoscopy of the pharynx via a tracheotomy incision is described.
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Over a period of 16 years, 26 horses were treated for open fractures involving the splint bones. Treatment consisted of surgical excision of fracture fragments and sequestra, and curettage of infected and unhealthy tissues. The splint bone distal to the fracture was removed in nine horses in which the attachment of the splint bone to the cannon bone via the interosseous ligament did not provide adequate stability. In two horses it was considered necessary to stabilise the proximal fragment by internal fixation and infection developed in both of them; one of these horses was destroyed on humane grounds. In the other 25 horses an excellent result was obtained in terms of cosmetic appearance and return to soundness.
Synovial fluid samples of horses with osteoarthritis were investigated to detect interleukin-1 (IL-1) activity which could contribute to the disease pathogenesis. Of the 32 samples tested, 12 (37.5 per cent) showed an augmented phytohaemagglutinin induced proliferation of C3H/HeJ mouse thymocytes. Positive results were also seen in horses with infected arthritis, osteochondritis, traumatic arthritis and undefined synovial effusions. Normal synovial fluid and sera from all groups failed to show any detectable IL-1 activity. Fractionation of synovial fluid showed that the IL-1 activity was in the 15 to 20 Kd fractions. In the absence of mitogen, synovial fluid failed to stimulate thymocytes and did not stimulate the growth of an interleukin-2 (IL-2) dependent CTLL cell line, but synovial fluid stimulated IL-2 release by mouse spleen cells incubated with suboptimal doses of lectin. Evidence of an IL-1 inhibitor in synovial fluid from osteoarthritic horses was provided by ultrafiltration experiments and by the inhibitory activity of synovial fluid at particular dilutions in the thymocyte assay. The presence of IL-1-like activity could be relevant in the pathogenesis of arthritis in horses.
Horse articular cartilage glycosaminoglycans (GAGs) were measured in synovial fluids from 48 joints affected with osteoarthritis (OA), 22 normal joints, four joints with osteochondritis, three joints with traumatic arthritis and seven joints infected with bacteria. Serum and urine from individual horses were also examined for the presence of GAGs. High levels of GAGs were found in synovial fluids (SF) from horses with OA. In each case, the level was higher in the synovial fluid than in the serum or urine from the same horse. Horses with OA showed high GAG levels in SF, serum and urine compared to horses with normal and infected joints. High levels were also found in horses with osteochondritis and traumatic arthritis. Levels of synovial fluid GAG reflect cartilage destruction in arthritis and may be useful for monitoring disease progression in the equine species.
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Degradation of cartilage in osteoarthritis of man results in the release of sulphated glycosaminoglycans, particularly keratan sulphate, into tissue fluids. A study was made to evaluate these markers for osteoarthritis in the horse. Synovial fluid and serum levels of keratan sulphate, measured by an ELISA-inhibition technique, and sulphated glycosaminoglycans measured by specific dye binding assay, were found to be significantly increased (P less than 0.001) in joints from horses with osteoarthritis, compared with normal joints. Synovial fluids from joints with infective arthritis also showed high keratan sulphate levels, but statistically were not significantly different from osteoarthritis. Measurement of serum/synovial fluid levels of proteoglycan may enable cartilage degeneration to be detected and monitored and help more effective treatments to be developed in the equine species.
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In 27 potential neuropathies an enzyme-linked immunosorbent assay, using P2 preparations from either bovine or equine myelin, detected all cases of cauda equina neuritis in which there was caudal involvement. The test was of limited value in differentiating neuropathies involving only cranial or other peripheral nerves.
A survey of 259 surgical colic cases revealed that over 50 per cent of fatalities occurred in the postoperative period. Postoperative ileus and circulatory/endotoxaemic shock accounted for 70 per cent of these deaths. Other less important complications were salmonellosis, long bone fracture, adhesions, haemorrhage, laminitis, wound infection and ischaemic muscle damage. Close monitoring of postoperative progress is necessary to enable early diagnosis and treatment. Recent developments in understanding of the pathophysiology of endotoxic shock and ileus may lead to more successful treatment regimes. The possibilities include the use of cyclooxygenase inhibitors, anti-endotoxin hyperimmune serum and dopamine antagonists.
During a 14 year period, 27 of 310 horses undergoing laparotomy because of abdominal pain were found to have an intussusception involving the small intestine (16 cases) or caecum (11 cases). The clinical signs, operative findings and techniques adopted to overcome the obstruction are described. An evaluation of possible predisposing factors provided further evidence of the important role of the tapeworm Anoplocephala perfoliata in initiating intussusception involving the ileum and caecum.
Intraoperative techniques for assessing the viability of ischaemic bowel are discussed. Intravenous administration of sodium fluorescein appears useful but further investigation of the method is required. Methods of resection and anastomosis of small intestine are described and illustrated, including the use of automatic stapling instruments.
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