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PubMed2000

Investigation of an outbreak of tapeworm-associated colic in a training yard.

A novel serological assay which measures IgG(T) specific for a 12/13 kDa protein of the equine tapeworm Anoplocephala perfoliata was used as part of a colic outbreak investigation. A training/rehabilitation yard for Thoroughbreds and Arabs was found to have an increasing incidence of colic over a 5 year period, culminating in a peak incidence of 1.15 episodes/horse year at risk. Four animals suffered from ileal impaction colic which necessitated surgical management. A case-control study design suggested a strong association between tapeworm infection and colic, with evidence of a dose-response relationship. Intervention, in the form of anticestode anthelminthics, coincided with a decrease in the incidence of colic and a fall in anti-12/13 kDa IgG(T) antibody levels of 8 horses monitored post-treatment. This study demonstrates that anthelminthic regimens, using exclusively ivermectin, may lead to an increase in tapeworm infection intensity which may in turn lead to an increased incidence of colic. Furthermore, it provides support to the hypothesis that the risk of ileal impaction colic and spasmodic colic increases with tapeworm infection intensity. The practical application of the anti-12/13 kDa IgG(T) ELISA is demonstrated by this study.

Animals↗
PubMed1998

Usefulness of history-taking, physical examination and diagnostic scoring in acute renal colic.

OBJECTIVE: The accuracy of the clinical diagnosis of acute renal colic was studied in connection with the survey of acute abdominal pain by the Research Committee of the World Organization of Gastroenterology. The diagnostic efficiency of various clinical symptoms, signs and tests have not previously been analyzed in the diagnosis of acute renal colic, and therefore the study is of potential importance. METHODS: 1,333 patients presenting with acute abdominal pain were included in the study. The clinical findings in each patient were recorded in detail, using a predefined structured data collection sheet, and the collected data were compared with the final diagnoses of the patients. Twenty-three clinical history variables, 14 clinical signs and 3 tests were evaluated in a single variable and multivariate analysis. RESULTS: In multivariate logistic regression analysis, the most significant predictors of acute renal colic were urine, tenderness, renal tenderness, duration of pain and appetite. The sensitivity in detecting acute renal colic was 0.84, with a specificity of 0.99 and an efficiency of 0.98. To sum up the contributions of most significant diagnostic factors, a diagnostic score (DS) was built. This score incorporated independent variables, e.g. urine, tenderness, renal tenderness, duration of pain, appetite and sex. The DS reached a sensitivity of 0.89 in detecting acute renal colic, with a specificity of 0.99 and an efficiency of 0.99. CONCLUSIONS: The results clearly show that acute abdominal pain with normal appetite, short duration of pain (</=12 h), loin or renal tenderness and hematuria (erythrocytes >10) are indicative of acute renal colic, and therefore, in this particular clinical question, careful history-taking and physical examination are of utmost importance. In our study, the DS system performed well considering the simple nature of its structure. However, to minimize the risk to the patient, we recommend that the DS is used only as an aid in decision-making when there is uncertainty as to the diagnosis of acute renal colic and the need for immediate treatment. In addition, the possibility of obstructive pyelonephritis in combination with renal colic should be considered clinically.

Acute Disease↗
PubMed2001

Estimate of the national incidence of and operation-level risk factors for colic among horses in the United States, spring 1998 to spring 1999.

OBJECTIVE: To estimate the national incidence of, operation-level risk factors for, and annual economic impact of colic among horses in the United States during 1998 and 1999. DESIGN: Epidemiologic survey. ANIMALS: 21,820 horses on 1,026 horse operations in 28 states. PROCEDURES: Horses were monitored for colic for 1 year, and results were recorded in a log that was collected quarterly. Operation-level data were collected via 4 on-site personal interviews. Associations between colic and independent variables adjusted for size of operation were determined. RESULTS: Annual national incidence of colic in the US horse population was estimated to be 4.2 colic events/100 horses per year. Case fatality rate was 11%, and 1.4% of colic events resulted in surgery. Annual cost of colic in the United States was estimated to be $115,300,000. CONCLUSIONS AND CLINICAL RELEVANCE: The national impact of equine colic is substantial because of the high case fatality rate.

Animals↗
PubMed2002

Survey of complications and antimicrobial use in equine patients at veterinary teaching hospitals that underwent surgery because of colic.

OBJECTIVE: To determine current practices regarding use of antimicrobials in equine patients undergoing surgery because of colic at veterinary teaching hospitals. DESIGN: Survey. SAMPLE POPULATION: Diplomates of the American College of Veterinary Surgeons performing equine surgery at veterinary teaching hospitals in the United States. PROCEDURE: A Web-based questionnaire was developed, and 85 surgeons were asked to participate. The first part of the survey requested demographic information and information about total number of colic surgeries performed at the hospital, number of colic surgeries performed by the respondent, and whether the hospital had written guidelines for antimicrobial drug use. The second part pertained to nosocomial infections. The third part provided several case scenarios and asked respondents whether they would use antimicrobial drugs in these instances. RESULTS: Thirty-four (40%) surgeons responded to the questionnaire. Respondents indicated that most equine patients undergoing surgery because of colic at veterinary teaching hospitals in the United States received antimicrobial drugs. Drugs that were used were similar for the various hospitals that were represented, and for the most part, the drugs that were used were fairly uniform irrespective of the type of colic, whereas the duration of treatment varied with the type of colic and the surgical findings. The combination of potassium penicillin and gentamicin was the most commonly used treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this study document the implementation of recommendations by several authors in veterinary texts that antimicrobial drugs be administered perioperatively in equine patients with colic that are undergoing surgery. However, the need for long-term antimicrobial drug treatment in equine patients with colic is unknown.

Animals↗
PubMed2005

Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 3: Long-term complications and survival.

REASONS FOR PERFORMING STUDY: Few studies have evaluated long-term survival and complication rates in horses following surgical treatment of colic, making it difficult to offer realistic advice concerning long-term prognosis. OBJECTIVE: To review the complications occurring after discharge from hospital and survival to >12 months after surgery of 300 horses undergoing exploratory laparotomy for acute colic. Pre-, intra- and post operative factors that affected long-term complications and long-term survival were assessed. METHODS: History, clinical findings, surgical findings and procedures and post operative treatments of 300 consecutive surgical colic cases (1994-2001) were reviewed. Long-term follow-up information was retrieved from case records and telephone enquiries from owners. RESULTS: The long-term (>12 months) survival rate for 204 horses discharged after colic surgery and for which follow-up information was available was 84%. The most common complication after discharge was colic, affecting 35.1% of horses following a single laparotomy. Colic was most common in horses that had had small intestinal obstructions, bowel resection or post operative ileus. Abdominal adhesions were most common in horses that presented with severe colic due to strangulation of small intestine. Ventral hernia formation occurred in 8% of horses, and was most common in horses that had had post operative wound drainage or infection. CONCLUSIONS: This study identified various factors that appear to predispose horses to long-term complications after colic surgery. POTENTIAL RELEVANCE: Further evaluation of strategies that might reduce the incidence of such complications are needed; in particular, the value of intraperitoneal heparin should be evaluated, and procedures designed to reduce the rates of wound drainage and infection assessed.

Animals↗
PubMedDate not supplied

The effect of fennel (Foeniculum Vulgare) seed oil emulsion in infantile colic: a randomized, placebo-controlled study.

CONTEXT: Despite its benign, natural course, colic is a significant problem in infants and imparts a psychological, emotional, and physical burden to parents. Dicyclomine hydrochloride is the only pharmacological treatment for infantile colic that has been consistently effective. Unfortunately, 5% of infants treated with dicyclomine hydrochloride develop serious side effects, including death. Fennel seed oil has been shown to reduce intestinal spasms and increase motility of the small intestine. However, there have not been any clinical studies of its effectiveness. OBJECTIVES: To determine the effectiveness of fennel seed oil emulsion in infantile colic. DESIGN: Randomized placebo-controlled trial. SETTINGS: Two large multi-specialty clinics. SUBJECTS: 125 infants, 2 to 12 weeks of age, who met definition of colic. INTERVENTION: Fennel seed oil emulsion compared with placebo. OUTCOME MEASURE: Relief of colic symptoms, which was defined as decrease of cumulative crying to less than 9 hours per week. RESULTS: The use of fennel oil emulsion eliminated colic, according to the Wessel criteria, in 65% (40/62) of infants in the treatment group, which was significantly better than 23.7% (14/59) of infants in the control group (P < 0.01). There was a significant improvement of colic in the treatment group compared with the control group [Absolute Risk Reduction (ARR) = 41% (95% CI 25 to 57), Number Needed to Treat (NNT) = 2 (95% CI 2 to 4)]. Side effects were not reported for infants in either group during the trial. CONCLUSION: Our study suggests that fennel seed oil emulsion is superior to placebo in decreasing intensity of infantile colic.

Colic↗
PubMed2006

Relationship between meconium staining, umbilical cord plasma motilin level and infantile colic.

OBJECTIVE: To assess the effects of meconium-stained amniotic fluid and umbilical cord plasma motilin levels on the development of infantile colic. STUDY DESIGN: One hundred forty pregnant women referred to our department for labor care were enrolled in the study. All subjects were laboring women with singleton, vertex-presenting fetuses, with a gestational age of > or = 36 weeks. After each infant with meconium-stained amniotic fluid was born, the following 2 infants without meconium were selected as controls. Umbilical cord plasma motilin levels were measured in 47 infants with meconium-stained amniotic fluid and 93 infants with no meconium. At the end of the third month of the infants' lives, the development of infantile colic was evaluated. Umbilical cord serum specimens were collected from 45 infants with colic and 95 infants without colic. Statistics included Student's t, chi2 and Mann-Whitney U tests, as appropriate. Multivariate analysis was performed. RESULTS: There was no correlation between the presence of meconium-stained amniotic fluid and the development of infantile colic. No association was found between umbilical cord plasma motilin levels and the development of infantile colic. Neonatal intensive care unit admission was found to be a significant risk factor for the development of infantile colic. CONCLUSION: Meconium-stained amniotic fluid and umbilical cord plasma motilin levels do not affect the development of infantile colic.

Amniotic Fluid↗
PubMed1986

Hemostatic abnormalities in equine colic.

Hemostatic profiles were determined in 30 horses with clinical colic. Blood samples were obtained at the time of the animal's admission, and the following hemostatic tests were done: blood platelet count, plasma fibrinogen, plasma antithrombin, prothrombin time, partial thromboplastin time, thrombin time, protamine sulfate test for soluble fibrin monomer, and fibrin-fibrinogen degradation products. The patients were categorized in retrospect, according to the cause of the colic: group 1--colic associated with colitis and/or severe diarrhea, group 2--colic associated with torsion or obstruction of the intestine, and group 3--colic associated with impaction of the intestine or the presence of enteroliths. Of the 30 horses with colic, 28 had at least 1 abnormality in their coagulogram--the most frequent abnormalities being high plasma fibrinogen concentration, high circulating soluble fibrin monomer, or a long partial thromboplastin time or thrombin time. The horses in group 1 seemed to have the most severe coagulopathies, as indicated by the average number of demonstrable abnormalities. The horses in group 3 showed the fewest abnormalities--usually a high plasma concentrations of fibrinogen and/or soluble fibrin monomer. The results indicated that hemostatic abnormalities are not uncommon in horses with gastrointestinal disease and colic--the degree of severity depending to some extent on the cause of the colic.

Animals↗
PubMed1985

Psychogenic colic in a horse.

A 4-year-old mixed-breed gelding was presented with colic-type behavior of 5 days' duration that included pawing, looking at the flank area, and kicking and biting at the abdomen and flank when it was eating hay or grain. Medical evaluation did not reveal the cause of the "colic." During its stay in the hospital, the horse improved as regarded the colic-type behavior while eating, but resumed this behavior when it was able to see hay that it was not allowed to eat. It was determined that the persistent colic-type behavior developed as a result of the horse having been repeatedly displaced from its food by other horses. When the horse performed the colic-type behavior, the owner would remain with it and effectively protect it from competitors. The initial bout of colic may have been a result of true colic, psychosomatic colic secondary to stress, redirected aggression, or displacement activity.

Animals↗
PubMed2001

Present-day imaging of patients with renal colic.

In the past decade alternatives to urography have been proposed for the study of patients with renal colic. In 1992 it was suggested to replace urography with KUB and ultrasonography. In 1993 the combination of KUB and ultrasonography followed by urography in unresolved cases was proposed and, in 1995, it was suggested to replace urography with unenhanced helical CT (UHCT). This article illustrates the contribution of UHCT to the study of patients with renal colic and analyses advantages and shortcomings of the technique compared with other diagnostic approaches. Diagnostics of the patient with renal colic is based on the detection of direct and indirect signs which allow identification of not only the calculus, with a sensitivity of 94-100% and accuracy of 93-98% according different authors, but also other signs that can serve to guide patient management and evaluate long-term prognosis. Unenhanced helical CT has the capability to detect extraurinary abnormalities which present with flank pain and mimic renal colic. The examination technique affects the quality of the images and therefore diagnostic accuracy as well as the dose to the patient. With regard to setting parameters, the choice of thickness and table feed should be guided by numerous factors. Multiplanar reconstruction is indicated in the study of the entire ureter course to identify the exact site of the calcification for the urologist to perform an evaluation similar to that obtained by urography. Many authors consider UHCT to be a valuable tool for suggesting the best therapeutic approach. Among these there are also urologists. The evaluation is based on the stone detection, its size and level in the urinary tract. Cost analysis shows that the cost of UHCT is equal to or inferior to the cost of urography. With regard to the dose, different data are reported in the literature. A high pitch (more than 1.5) and a thin collimation (3-mm thickness) are good compromise between quality and dose which can be compared to the dose of normal urography. What is to be done if helical CT is not available? If helical CT is not available, plain film plus ultrasonography should be considered. This approach does not solve all the cases; in unresolved cases urography is indicated. It should also be noted that US has a good sensitivity in detecting other conditions such as biliary lithiasis, acute pancreatitis, acute appendicitis and abdomino-pelvic masses which are responsible for pain that mimics renal colic. In conclusion, IVU should not have any more the priority in investigating the patients with renal colic. Helical CT should be the first choice in imaging a patient with renal colic. If this technique is not available, plain film and ultrasonography should be considered adding urography in unresolved cases.

Colic↗
PubMed1989

Use of indomethacin suppositories in the prophylaxis of recurrent ureteral colic.

To determine the effects of indomethacin suppositories in the relief of acute colic and prevention of recurrent colic, we instituted a prospective double-blind, placebo-controlled protocol. Patients were randomized to receive either 50 mg. indomethacin or placebo suppositories every 8 hours and all patients received prescriptions for supplemental narcotics to be used on an as needed basis. Relief of colic was assessed by counting the total number of supplemental narcotics used by each patient per 24 hours during the study period, which was defined as until passage of the calculus or 5 days. There were 41 patients entered into the study protocol and complete followup was available for 26. Mean calculus size was 3.4 mm. in the indomethacin group versus 3.1 mm. in the placebo group. All 13 patients in the control group had recurrent episodes of colic and 8 of these 13 had more than 1 recurrent episode. Five patients in the placebo group required admission to the hospital for control of pain. In contrast, only 4 of the 13 patients in the treatment group had colic and only 1 had more than 1 episode of colic. No patient in the active drug group required admission to the hospital for control of pain. Over-all the ratio of supplemental narcotic used by the placebo group versus the indomethacin group was 7.6:1 (p less than 0.005). The mean interval time to passage of the calculus was slightly lower in the indomethacin group (89 versus 82 hours) but this difference was not statistically significant (p greater than 0.10). Our data strongly support the use of indomethacin suppositories in the prevention of recurrent colic secondary to ureteral calculi.

Colic↗
PubMed2000

[Efficient, immediate or emergency ESWL: an attractive strategic alternative to be considered in the treatment of renal colic!].

INTRODUCTION: Renal colic due to acute ureteral obstruction caused by lithiasic impact results in severe rise of intracavitary pressure. Traditional drug therapy (painkillers, anti-inflammatories, spasmolytics) is symptomatic and provisional, and pain can reappear when obstruction is maintained. A pathoetiological approach would be the ultimate therapy vs the symptomatic one. MATERIAL AND METHODS: From the beginning, the approach used at the Lithiasis-Lithotrity Unit at the FJD, once the ureteral stone is accurately identified during a renal colic, is that of immediate or emergency "in situ" SWEL together with the usual drug therapy. 15% of 2100 cases of ureteral lithiasis treated (1991-1999) were renal colic. RESULTS: Renal colic can be resolved in all cases (100%) even when fragmentation may be partial and/or require a second deferred SWEL on remnants of the first lithiasis. When obstruction has been resolved, pain does not reappear as it happens with the effects of analgesics. DISCUSSION: Placement of a ureteral catheter or nephrostomy for analgesia in order to perform deferred SWEL of the ureteral stone origin of the acute ureteral obstruction and the renal colic, do not improve SWEL results. There are physical reasons to support the practice of immediate or emergency "in situ" SWEL during a renal colic. Fragmentation of the obstructive stone together with the resulting ureteral oedema allow urine passage. Intracavitary pressure and pain disappear when the obstruction is withdrawn. CONCLUSIONS: Immediate, "in situ" or emergency SWEL in cases of obstructive ureteral stones during a renal colic, is an attractive strategic alternative for drug therapy that should be considered mainly in institutions with means to perform the procedure.

Colic↗
PubMed2001

Infants with colic have a normal sleep structure at 2 and 7 months of age.

OBJECTIVE: To compare nighttime sleep structure between infants with colic and a control group. STUDY DESIGN: Sleep and cry times of 15 infants with colic and 16 infants in a control group were recorded with the use of a daily diary at the ages of 5 weeks and 6 months. The diary was kept at home for a 1-week period. Overnight polygraphic sleep recordings in a sleep laboratory were performed when the infants were 2 months of age and were repeated for 11 infants with colic and 14 infants in a control group at 7 months of age. RESULTS: Daily sleep time was shorter in infants with colic compared with the control group at 5 weeks of age (P =.001). Polygraphic data showed a similar sleep structure between the study groups at 2 and 7 months of age. Infants with colic had somewhat more obstructive apneas during rapid eye movement sleep at the age of 2 months (P =.04), and they had fewer awakenings at the age of 7 months than the control group (P =.003). CONCLUSION: Infants with colic had normal sleep polygraphic finding at 2 and 7 months of age including sleep structure, movements, and breathing. Despite the shorter reported daily sleep times, the polygraphic data did not suggest infantile colic to be associated with a sleep disorder.

Colic↗
PubMed1991

Severe infantile colic and food intolerance: a long-term prospective study.

To determine the relationship between infantile colic and cow's milk protein intolerance (CMPI) in formula-fed infants, 70 infants (38 male, 32 female) were selected, with mean age 30.2 +/- 21.4 days, with severe colic (duration of crying greater than 4 h per day for 5 days per week). In 50 of the infants in the study group (71.4%) there was a remission of symptoms when cow's milk protein (CMP) was eliminated from the diet. Two successive challenges caused the return of symptoms in all these 50 infants. There was a positive anamnesis for atopy in 9 of 50 of the patients with CMP-related colic and in 1 of 20 of those with non-CMP-related colic (p greater than 0.05). A follow-up period of 18 months' mean duration showed that 22 of 50 (44%) of the infants with CMP-related colic and 1 of 20 (5%) of those with non-CMP-related colic developed an overt alimentary intolerance (p less than 0.02). We conclude that a considerable percentage of the infants with severe colic also have CMPI and that in these cases, dietetic treatment should be the first therapeutic approach.

Colic↗
PubMed2002

Cimetropium bromide in the treatment of crisis in infantile colic.

BACKGROUND: Treatment of infantile colic remains an open issue. In Italy, cimetropium bromide is used extensively to treat infantile colic. The aim of this randomized, double-blind, placebo-controlled clinical trial was to investigate the effectiveness and side effects of cimetropium bromide in the treatment of infants with colic crisis. METHODS: Ninety-seven infants with colic were enrolled. The diagnosis of infantile colic in healthy infants with regular growth, aged 15 to 60 days was made according to the criteria of Wessel. The infants were divided into two groups, one treated with cimetropium bromide (1.2 mg/kg) and the other treated with placebo at onset of each crisis for 3 days. Duration of crying and side effects were recorded daily in a structured diary for the 3 days of therapy. Statistical analysis was performed using the chi-square and t tests. RESULTS: Eighty-six infants completed the trial. The average duration of crying for each crisis was 17.3 +/- 12.6 minutes in the cimetropium bromide group and 47.5 +/- 28.5 minutes in the placebo group (P < 0.005). Response to cimetropium bromide was 74%. Response to placebo was 33% (P < 0.05). Side effects did not differ significantly between the two groups, except sleepiness, which increased in the infants treated with cimetropium bromide. CONCLUSION: Cimetropium bromide was more effective than placebo in reducing the duration of crying in children with infantile colic. The use of the anticholinergic drugs, aside from the dicyclomine because of its dangerous side effects, should be revaluated for treating infantile colic.

Colic↗
PubMed2004

Comparison of the effect of diclofenac with hyoscine-N-butylbromide in the symptomatic treatment of acute biliary colic.

BACKGROUND: Although non-steroidal anti-inflammatory drugs (NSAID) and spasmolytics have been used to relieve biliary colic, the role of these drugs in the natural history of biliary colic has not been clarified. The objective of the present study is to compare the efficacy of intramuscular diclofenac with intramuscular hyoscine in the treatment of pain of acute biliary colic, and to study their role in the natural history of biliary colic and in the prevention of cholelithiasis-related complications. METHODS: Seventy-two consecutive patients with biliary colic were enrolled in this prospective, randomized, double-blind study. They received either a single 75 mg intramuscular dose of diclofenac (n = 36) or similarly administered 20 mg of hyoscine (n = 36). Pain severity was recorded on a visual analogue scale 30 min, 1 h, 2 h and 4 h after injection of the drug. Patients were then followed closely for the next 72 h for persistence or relapse of pain, or development of acute cholecystitis, or drug related complications. RESULTS: Diclofenac provided much more rapid relief of pain than hyoscine, as shown by significantly lesser pain scores after injection of the drug. 91.7% of patients on diclofenac were completely relieved of pain at 4 h as compared to 69.4% with hyoscine (P = 0.037). Progression to acute cholecystitis was seen in only 16.66% of patients on diclofenac as compared to 52.77% on hyoscine (P = 0.003). CONCLUSIONS: In patients with biliary colic, diclofenac gives much faster and more effective pain relief in a significantly larger number of patients as compared with hyoscine. Most remarkably, diclofenac can prevent progression of biliary colic to acute cholecystitis in a significant number of patients.

Acute Disease↗
PubMed1992

A two year, prospective survey of equine colic in general practice.

The records of 200 colic episodes, collected prospectively, over a two year period, from first opinion cases, were analysed and compared with a control sample selected at random from the same population. Analysis by colic type revealed 72% spasmodic/undiagnosed; 7% surgical; 5.5% flatulent; 5% pelvic flexure impactions; 9.5% other implications and 1% colitis. A possible predisposing cause was identified in 43% of the spasmodic/undiagnosed cases. The total incidence of colic in each age group showed no statistically significant differences from the control population. Stallions were significantly under represented in the colic population. When compared with the control sample the number of spasmodic/undiagnosed colic cases in the 5-10-year-old group and the number of surgical colics in the over 15-year-old group were significantly greater than expected. No statistically significant correlation was found when the seasonal incidence of colic was compared with monthly temperature, change in monthly temperature, monthly rainfall, and rainfall weighted for temperature.

Age Factors↗
PubMed1993

Are tapeworms associated with equine colic? A case control study.

Faeces samples from 116 horses with colic and 115 non-colic cases were assayed by a centrifugation/floatation method for the presence of tapeworm eggs. Analysis of these data failed to demonstrate an association between tapeworm infection and colic of all types. The data were further analysed according to anatomical site of the lesion causing colic. The risk of ileocaecal colic was increased in the presence of tapeworms. Age, breed and sex were evaluated as possible confounding factors but had no association with the incidence of colic. This study suggests an association between tapeworms and colic of ileocaecal origin.

Animals↗