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Biomedical subjects

Robert K Schneider

Publications and source records attributed to Robert K Schneider.

13 recordsLinked to original sources
PubMed2006

Use of magnetic resonance imaging to diagnose distal sesamoid bone injury in a horse.

CASE DESCRIPTION: A 5-year-old Appaloosa mare was examined for severe left forelimb lameness of 4 months' duration. CLINICAL FINDINGS: Lameness was evident at the walk and trot and was exacerbated when the horse circled to the left. Signs of pain were elicited in response to hoof testers placed over the frog of the left front hoof, and a palmar digital nerve block eliminated the lameness. Radiographs revealed no abnormalities, but magnetic resonance imaging (MRI) revealed increased bone density in the medullary cavity of the distal sesamoid (navicular) bone in the proton density and T2-weighted images and a defect in the fibrocartilage and subchondral bone of the flexor cortex. TREATMENT AND OUTCOME: Because of the absence of improvement after 4 months and the poor prognosis for return to soundness, the mare was euthanatized. An adhesion between the deep digital flexor tendon and the flexor cortex defect on the navicular bone was grossly evident, and histologic evaluation revealed diffuse replacement of marrow trabecular bone with compact lamellar bone. Changes were consistent with blunt traumatic injury to the navicular bone that resulted in bone proliferation in the medullary cavity. CLINICAL RELEVANCE: Use of MRI enabled detection of changes that were not radiographically evident and enabled accurate diagnosis of the cause of lameness. Navicular bone injury may occur without fracture and should be considered as a differential diagnosis in horses with an acute onset of severe unilateral forelimb lameness originating from the heel portion of the foot.

Animals↗
PubMed2006

Detection of an epidermoid cyst in the foot of a horse by use of magnetic resonance imaging.

CASE DESCRIPTION-A 4-year-old Quarter Horse stallion was evaluated because of a 10-month history of moderate (grade 3/5) left forelimb lameness (detectable during trotting over a smooth, hard surface). CLINICAL FINDINGS-No abnormalities were detected in either forelimb via palpation or application of hoof testers; however, lameness was eliminated after administration of a palmar digital nerve block in the left forelimb. Whereas radiography and ultrasonography did not identify any left forelimb foot abnormalities, magnetic resonance (MR) imaging revealed a circumscribed soft tissue mass in the distal aspect of the digital flexor tendon sheath (DFTS) dorsal to the lateral aspect of the deep digital flexor tendon. Subsequently, the left forelimb DFTS was injected with local anesthetic, which resulted in 90% improvement of the horse's lameness. TREATMENT AND OUTCOME-The distal aspect of the left forelimb DFTS was evaluated tenoscopically. The mass was removed under tenoscopic guidance, after which the distal digital annular ligament was transected. The horse received phenylbutazone orally for 10 days, and the left forelimb DFTS was injected with hyaluronic acid and methylprednisolone acetate 7 days after the surgery. Following a rehabilitation program, the horse was returned to full training at 6 months after surgery and competed successfully during a 2-year follow-up period. CLINICAL RELEVANCE-Use of MR imaging should be considered in all lame horses for which a definitive diagnosis cannot be made via radiography, ultrasonography, or other imaging techniques, especially when the lameness has been localized to a specific anatomic region by use of diagnostic anesthesia.

Animals↗
PubMed2005

Septic arthritis and granulomatous synovitis caused by infection with Mycobacterium avium complex in a horse.

A 12-year-old American Saddlebred gelding was referred to a veterinary teaching hospital for evaluation of a chronic lameness problem in the right radiocarpal joint. The horse had been treated for osteoarthritis of the right radiocarpal joint with multiple injections of cortisone during the past 3 years. The horse was severely lame on the right forelimb at a trot. Radiography and computed tomography revealed a 3 x 2-cm lytic defect in the distal portion of the radius and periarticular bone proliferation around the right radiocarpal joint. Ultrasonography of the distal portion of the radius revealed a soft tissue mass in the palmarolateral aspect of the joint. Proliferative synovium with a large amount of fibrin was observed in the dorsal and palmar aspects of the joint via arthroscopic examination of the right radiocarpal joint. Histologic examination of synovial biopsy specimens revealed proliferative granulomatous synovitis with giant cells. Mycobacterium avium complex was cultured from the synovial fluid. Infection with M avium complex should be considered in horses with chronic recurring arthritis associated with granulomatous synovitis.

Animals↗
PubMed2005

Arthrodesis techniques in horses.

When medical therapy and surgical treatments of an injured joint fail to return the animal to athletic performance or comfortable use of the limb, arthrodes is is a final option for some joints. Arthrodesis refers to the surgical fusion of a joint, resulting in bony ankylosis. Successful arthrodesis requires debridement of the articular cartilage through the calcified cartilage layer, exposing the subchondral bone; alignment of the joint into a weight-bearing position; and stabilization. The methods by which these steps are accomplished are variable, depending on the individual joint. There are currently accepted methods for arthrodesis of several joints in the horse; however, not all joints are amenable to arthrodesis. Case selection is an important aspect of performing arthrodesis procedures in horses.

Animals↗
PubMed2004

Use of magnetic resonance imaging identify suspensory desmitis and adhesions between exostoses of the second metacarpal bone and the suspensory ligament in four horses.

Four horses were examined because of chronic forelimb lameness. In all horses, the cause of the lameness was localized to the metacarpus by means of physical examination and diagnostic anesthesia, and radiography of the affected limb revealed a small exostosis of the second metacarpal bone. Magnetic resonance imaging revealed suspensory desmitis in the region of this exostosis in all 4 horses. In addition, an abnormal area of low signal intensity, suggestive of an adhesion, was seen between the exostosis and the suspensory ligament. In all horses, an adhesion between the suspensory ligament and the exostosis on the second metacarpal bone was identified and transected at surgery, and the exostosis and distal portion of the second metacarpal bone were removed. All horses were able to return to their previous athletic use following a 6-month rest and rehabilitation program for treatment of the suspensory desmitis. Findings in these horses suggest that adhesions between the suspensory ligament and an exostosis of the second metacarpal bone may be a cause of chronic or recurrent forelimb lameness in horses.

Animals↗
PubMed2004

Use of magnetic resonance imaging for identifying subchondral bone damage in horses: 11 cases (1999-2003).

OBJECTIVE: To assess the use of magnetic resonance (MR) imaging for identifying subchondral bone damage in the distal limbs of horses. DESIGN: Retrospective study. ANIMALS: 11 horses. PROCEDURE: Medical records of horses with lameness and subsequent evidence of subchondral bone damage as determined by MR imaging were reviewed. Severity and duration of lameness, results of diagnostic local anesthesia and diagnostic testing, surgical and necropsy findings, and treatment were recorded. Outcome was determined by follow-up information obtained from the owner or referring veterinarian. RESULTS: Lameness was localized by physical examination and diagnostic local anesthesia. Lameness was localized to the metacarpophalangeal or metatarsophalangeal joint in 4 horses, distal interphalangeal joint in 5 horses, and tarsocrural joint in 2 horses. The duration of lameness ranged from 2 weeks to 20 months. Magnetic resonance imaging of the affected joints revealed abnormal fluid accumulation within the subchondral bone. None of the abnormalities observed by MR imaging were detected by radiography. Subchondral bone damage was diagnosed in all horses. Arthroscopy of the affected joint was performed in 4 horses. Communication with the articular surface of the affected bone was suspected on the basis of results of MR imaging in 4 horses and was confirmed by arthroscopy in 1 horse and by necropsy in 1 horse. CONCLUSIONS AND CLINICAL RELEVANCE: Magnetic resonance imaging was useful for providing a diagnosis when other imaging techniques did not definitively identify the cause of lameness. Subchondral bone damage was clearly identified by MR imaging and should be considered as a cause of lameness in horses in which radiographic findings are unremarkable.

Animals↗
PubMed2003

Desmitis of the straight sesamoidean ligament in horses: 9 cases (1995-1997).

OBJECTIVE: To determine clinical signs, diagnostic findings, and outcome for horses with desmitis of the straight sesamoidean ligament (SSL) near its insertion on the middle phalanx. DESIGN: Retrospective study. ANIMALS: 9 horses. PROCEDURE: Medical records were reviewed, and information on signalment, history, clinical signs, diagnostic findings, and treatment was obtained. Follow-up information was obtained through telephone conversations with owners. RESULTS: In all horses, the diagnosis was made by use of high-resolution ultrasonography. Seven horses had moderate lameness on initial examination; lameness was exacerbated in 6 horses following flexion of the distal limb joints. The cause of lameness could not be determined on the basis of clinical signs, and diagnostic local anesthesia was necessary to localize the source of lameness to the distal portion of the limb. Five horses had forelimb involvement (1 bilateral), and 4 had hind limb involvement (1 bilateral). Treatment consisted primarily of a 6-month rest and rehabilitation program. Six of the 9 horses were able to return to their intended use. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that injury to the SSL proximal to its insertion on the middle phalanx should be considered as a possible cause of lameness in horses, particularly performance horses, with lameness localized to the distal portion of the forelimb or hind limb that do not have any radiographic abnormalities. High-resolution ultrasonography was necessary to make the diagnosis. Horses with an acute injury appeared to have a reasonable chance of responding to treatment and returning to their intended use.

Animals↗
PubMed2002

Psychiatric presentations of non-HIV infectious diseases. Neurocysticercosis, Lyme disease, and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection.

Infectious diseases can cause an array of symptoms, including psychiatric symptoms. Psychiatrists serving the medically ill need to be aware not only of classic infectious diseases (e.g., neurosyphilis and HIV), but also of less commonly discussed infectious diseases (e.g., NCC, PANDAS, and Lyme disease). These examples represent an internationally endemic disease (e.g., NCC), a probable immunogenetic disease (e.g., PANDAS), and a frequently overdiagnosed and overtreated disease (Lyme disease).

Adult↗
PubMedDate not supplied

A direct comparison of presenting characteristics of depressed outpatients from primary vs. specialty care settings: preliminary findings from the STAR*D clinical trial.

PURPOSE: No study has directly compared the clinical features of depression for patients entering clinical trials using identical enrollment criteria at primary care (PC) and specialty care (SC) settings. The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (http://www.star-d.org) provides a unique opportunity to provide this comparison for patients with a major depressive disorder (MDD) requiring treatment. SUBJECTS AND METHODS: We report baseline data for the first 1500 patients enrolled in this trial involving 41 clinic sites (18 PC, 23 SC). Broadly inclusive eligibility criteria required that patients have a DSM-IV diagnosis of nonpsychotic MDD, have not failed an adequate medication trial during their current episode and score>or=14 on the 17-item Hamilton Rating Scale for Depression (HAM-D17). Primary outcomes included the 30-item Inventory of Depressive Symptomatology-Clinician-Rated (IDS-C30) and the HAM-D17. RESULTS: Specialty care and PC patients had equivalent degrees of depressive severity (IDS-C30=35.8; HAM-D17=20.4). Specialty care patients were almost twice as likely to report a prior suicide attempt than PC patients (21% vs. 12%, P<.0001) and slightly less likely to endorse suicidal ideation in the past week (45.0% vs. 50.8%, P=.006). The only other distinguishing core symptoms were a slightly lower likelihood of PC patients endorsing depressed mood (95.2% vs. 97.7%, P=.032) or anhedonia (66.3% vs. 70.7%, P=.042, IDS-C30) and a lower likelihood of PC patients endorsing weight loss (IDS-C30). HAM-D17 results were identical. CONCLUSION: Depressive severity was not different, and symptomatic presentations did not differ substantially. Major depressive disorder is more similar than different among patients at SC and PC settings. Thus, similar clinical and research methods for screening, detecting and measuring treatment outcomes can be applied in both settings.

Ambulatory Care↗
PubMedDate not supplied

Use of a hydro-pool system to recover horses after general anesthesia: 60 cases.

OBJECTIVE: To report complications observed using a hydro-pool recovery system after general anesthesia in horses. STUDY DESIGN: Retrospective study. ANIMALS: Sixty horses. METHODS: Retrospective review of the medical records and quality of recovery from anesthesia of 60 horses that had surgical or diagnostic procedures under general anesthesia. RESULTS: Mean total anesthesia time was 182 minutes (range, 25 to 390 minutes). Mean time in the hydro-pool was 108 minutes (range, 20 to 270 minutes). One horse that had bilateral rear limb extensor weakness while recovering in a padded recovery stall was moved to the hydro-pool and maintained for 12 hours. Ten horses developed some pulmonary edema; in 3 horses, the signs of pulmonary edema were severe; and 1 horse died from related complications. One horse developed septic arthritis of an operated stifle joint, and 2 horses developed incisional infections. Two horses incurred multiple skin abrasions on the distal aspect of their limbs during violent attempts to leave the pool. CONCLUSIONS: A hydro-pool system was useful for recovering horses from general anesthesia when difficult recoveries were anticipated because of the horse's injury, size, demeanor, duration of anesthesia, or risk of further injury. Recovery using the hydro-pool was more time and labor intensive than a standard stall recovery. Pulmonary edema that required treatment was a serious complication that occurred in 17% of the horses. Careful closure of the skin with cyanoacrylate glue and pressure from bandages were used to prevent postoperative incisional infections. CLINICAL RELEVANCE: A hydro-pool system is a useful method for recovering horses from general anesthesia when difficult recoveries are anticipated.

Anesthesia Recovery Period↗
PubMedDate not supplied

Comparison of three methods for arthrodesis of the distal intertarsal and tarsometatarsal joints in horses.

OBJECTIVE: To evaluate the effects of diode laser surgery (LS), surgical drilling (SD), and intraarticular sodium monoiodoacetate (MIA) as methods for fusing the distal intertarsal (DIT) and tarsometatarsal (TMT) joints in horses. STUDY DESIGN: Experimental study. ANIMALS: Adult horses (15) without radiographic signs of osteoarthritis (OA) of the DIT and TMT joints. METHODS: Group 1 (n=3) had LS performed bilaterally on DIT and TMT joints; 1 horse was evaluated for 1 week and 2 horses were evaluated for 2 weeks. Group 2 (n=6) had LS on DIT and TMT joints of 1 tarsus and MIA administration into the contralateral DIT and TMT joints and were evaluated for 6 months. Group 3 (n=6) had LS performed on DIT and TMT joints of 1 tarsus and SD of the contralateral DIT and TMT joints and were evaluated for 12 months. Postoperative comfort, lameness, radiography, microradiography, and histology scores were compared using repeated measures ANOVA, and paired or 2 sample t-tests; significance was set at P<.05. RESULTS: LS caused the least postoperative morbidity. In group 2, horses were less lame in 4 LS-treated limbs and 2 MIA-treated limbs at 6 months when compared with the contralateral limb. In group 3, horses were less lame in 5 LS-treated limbs and 1 SD-treated limb at 6 and 12 months compared with the contralateral limb. On microradiography, 11 MIA joints and 2 LS joints had bone bridging the joint at 6 months whereas 8 SD joints and 5 LS joints had bone bridging at 12 months. Significantly more joint space was bridged by bone in MIA- (51.4%) and SD (46.2%)-treated joints compared with LS joints at 6 (30.6%) and 12 (28.5%) months, respectively (P<.05). CLINICAL RELEVANCE: SD and MIA resulted in more bone bridging of the distal 2 tarsal joints, than LS. However, LS seemingly caused less pain and discomfort to horses in the immediate postoperative period; horses were generally less lame in the LS limb. More laser energy may need to be applied to these joints to promote fusion; however, it may also have beneficial effects beyond fusion. Further research on horses with OA of the distal 2 tarsal joints is needed to determine whether LS can cause soundness without facilitating bony fusion.

Animals↗