Optimal microneedle length for hair regrowth in hair cycle arrest (alopecia X) in six dogs.

BACKGROUND: Hair cycle arrest (HCA) is a chronic alopecic disorder in dogs. Clinical responses vary and are often insufficient. Microneedling (MN) has been used as a successful treatment for HCA in dogs; ideal protocols have not yet been established. OBJECTIVES: The objective of the study was to compare the efficacy and safety of three needle lengths for MN in dogs with HCA. ANIMALS: Six unrelated client-owned dogs, including five Pomeranians and one mixed-breed dog, diagnosed with HCA. MATERIALS AND METHODS: Individual alopecic sites were divided into three sections. For each section, different lengths of needles (1, 2 and 3 mm) were used. Efficacy and safety were evaluated at 1, 3 and 6 months. Treated sections were monitored for 20 months. RESULTS: Three months after treatment with 3 mm needles, all sections showed hair regrowth. There was no hair regrowth in two of six sections treated with 2 mm needles, and four of six sections did not show a response to treatment with 1 mm needles. Two dogs developed transient pruritus. Five of six dogs had recurrent hair loss between 5 and 16 months of follow-up. CONCLUSION AND CLINICAL RELEVANCE: Microneedling using longer needles stimulated better hair regrowth in dogs with HCA. Alopecia relapsed in most dogs and minor pruritus occurred in some dogs.

Inadvertent removal of a needle foreign body via endoscopic suctioning in a dog.

A 6-month-old intact female English bulldog was presented following witnessed ingestion of a sewing needle. The dog underwent attempted endoscopic retrieval under general anesthesia. The needle foreign body was visualized but could not be removed due to orientation, and subsequent attempts at visualization were unsuccessful. Due to the unsuccessful removal, radiographs were obtained before intended surgical exploration, and no sewing needle was identified. The needle was subsequently identified in the working channel of the endoscope, and the dog recovered uneventfully. This is the first report to describe inadvertent endoscopic suctioning of a sharp, needle foreign body. Key clinical message: Endoscopy is a key tool in the management and treatment of sharp gastric foreign bodies. Complications are uncommon and typically patient-focused, including gastric perforation or irritation. However, this case report identifies an additional complication that should be considered when endoscopy is not successful.

Retrait par inadvertance d'un corps étranger par aspiration endoscopique d'une aiguille chez un chienUne femelle bouledogue anglais intacte de 6 mois a été présentée après l'ingestion d'une aiguille à coudre en présence d'un témoin. La chienne a subi une tentative de retrait endoscopique sous anesthésie générale. L'aiguille a été visualisée mais n'a pas pu être retirée en raison de l'orientation, et les tentatives ultérieures de visualisation ont échoué. En raison de l'échec du retrait, des radiographies ont été obtenues avant l'exploration chirurgicale prévue, et aucune aiguille à coudre n'a été identifiée. L'aiguille a ensuite été identifiée dans le canal opérateur de l'endoscope, et le chien s'est rétabli sans incident. Il s'agit du premier rapport décrivant l'aspiration endoscopique par inadvertance d'un corps étranger pointu ou tranchant.Message clinique clé :L'endoscopie est un outil essentiel dans la gestion et le traitement des corps étrangers gastriques tranchants. Les complications sont rares et généralement axées sur le patient, notamment la perforation ou l'irritation gastrique. Cependant, ce rapport de cas identifie une complication supplémentaire qui doit être envisagée lorsque l'endoscopie n'est pas réussie.(Traduit par Dr Serge Messier).

Diagnostic needle arthroscopy of the scapulohumeral joint in standing sedated horses.

OBJECTIVE: To describe the technique to perform diagnostic standing scapulohumeral joint needle arthroscopy with a 1.2-mm-diameter arthroscope in horses. STUDY DESIGN: Experimental study. ANIMALS: Eight thoracic limbs in phase 1 and six horses in phase 2. METHODS: In phase 1, the feasibility of the technique was evaluated by using a craniolateral arthroscopic approach. An evaluation of the visible structures of the scapulohumeral joint was performed with both a needle arthroscope and a 4-mm-diameter arthroscope. In phase 2, the technique was performed in six healthy sedated horses to validate the technique in live animals and to report any complications or limitations. RESULTS: In phase 1, joint evaluation was similar between arthroscopes and allowed complete evaluation of approximately the lateral half of the humeral head and the lateral glenoid rim. In phase 2, all joints were successfully accessed, and fluid extravasation was mild. Arthroscopic visualization was complete for the centrolateral aspect of the joint in all horses and either complete (3/6) or partial (3/6) for the craniolateral and caudolateral structures, respectively. The procedure was rapidly performed and well tolerated, and no postoperative complications occurred. CONCLUSION: The described technique was simple and allowed direct inspection of the scapulohumeral joint. Nonetheless, the standing nature of the technique prevents evaluation of the medial aspect of the humeral head and most of the glenoid cavity. CLINICAL SIGNIFICANCE: Needle arthroscopy of the scapulohumeral joint is feasible in horses and offers a diagnostic technique that may improve the surgeon's diagnostic ability for certain shoulder pathologies.

Along or across the visual axis: a comparison of two ultrasound screen, needle and transducer orientation techniques.

OBJECTIVE: To evaluate two transducer and needle handling methods, along the visual axis (AL) and across the visual axis (AC), in non-skilled and skilled clinicians. STUDY DESIGN: Prospective randomized crossover study. METHOD: A total of 26 students with no ultrasound locoregional anaesthesia experience (non-skilled group) and six clinicians experienced and familiar with ultrasound locoregional anaesthesia (skilled group) were enrolled. The non-skilled group was asked to perform two tasks: the first on a phantom and the second on canine cadavers, whilst the skilled group performed only the second task. The tasks consisted of guiding the tip of the needle to a target point (simulated nerve on the jelly phantom and sciatic nerve on the cadavers) using two different methods of needle handling-AL or AC. All operators performed each task three times for each method. The time to drive the needle to the target for the two methods was analysed with a paired Student t test, and the number of times the needle was not visualized on the screen between the groups was compared using an unpaired Student t test. Data are presented as mean ± standard deviation. Value of p < 0.05 was considered significant. RESULTS: The AL method, compared with the AC method, resulted in shorter performance time in both skilled (9 ± 5 versus 20 ± 8 seconds for the second task) and non-skilled groups (9 ± 8 versus 17 ± 15 seconds for the first task and 18 ± 11 versus 32 ± 26 seconds for the second task). CONCLUSION AND CLINICAL RELEVANCE: In both groups, the AL method significantly reduced the time to complete the task. Results from this study indicate that the AL method should be the preferred method for learning/teaching ultrasound-guided regional anaesthesia.

Needle arthroscopy of the radiocarpal and middle carpal joints in standing sedated horses.

OBJECTIVE: To develop a technique for standing diagnostic needle arthroscopy of the radiocarpal and middle carpal joints in standing sedated horses. STUDY DESIGN: Experimental study. ANIMALS: Six cadaveric forelimbs (phase 1) and six healthy horses (phase 2). METHODS: In phase 1, six cadaveric forelimbs were used to assess needle arthroscopic evaluation of both joints. Six healthy horses were subsequently enrolled in phase 2 to validate the procedure in live animals. The joint was maintained in flexion with a custom-made splint and base. RESULTS: In phase 1, needle arthroscopy allowed thorough evaluation of the dorsal and palmar recesses of both joints with traditional arthroscopic portals. In phase 2, joint evaluation was also thorough but only dorsal approaches were performed. All horses underwent radiocarpal joint arthroscopy, whereas the middle carpal joint was evaluated in only three of six horses because of limb movement. The technique was quickly performed and well tolerated by all horses. Complications included moderate movement, mild iatrogenic cartilage damage, and mild hemarthrosis. CONCLUSION: Standing needle arthroscopy allowed thorough evaluation of the dorsal aspect of both joints, although only three of six middle carpal joints were assessed because of movement limitations. CLINICAL SIGNIFICANCE: The proposed technique offers an alternative diagnostic tool for radiographically silent intra-articular lesions of the carpus while initially avoiding the cost and risks associated with general anesthesia. Arthroscopy of a single joint is recommended to minimize risks associated with movement during the procedure.

Effects of needle gauge and syringe size on small intestinal leakage at injection sites.

OBJECTIVE: To determine the influence of needle gauge, syringe volume, and syringe size on needle tract leakage after injection in porcine jejunum. STUDY DESIGN: Ex vivo experiment. SAMPLE POPULATION: Three hundred sixty jejunal segments from 20 feedlot pigs. METHODS: Fresh porcine intestines were divided into 5-cm or 10-cm segments and randomly assigned to the one of nine treatment groups: 25-gauge, 22-gauge, and 20-gauge needles attached to full 12-mL, half-full 20-mL, and full 20-mL syringes (n = 20/group). The jejunal segments were occluded with Rochester-Carmalt forceps prior to injection of diluted India ink. Injection time and leakage were noted by a blinded observer. Multivariate analysis was used with segment size, needle gauge, volume infused, time to inject per milliliter, and syringe size as variables. RESULTS: Leakage occurred in 36% of 5-cm and 15% of 10-cm segments and was immediate without palpation in 33.8% and 11% of segments, respectively. Protective effects were seen for 22-gauge needles in both 5-cm (P = .002) and 10-cm (P = .001) segments, whereas injection of 20 mL had a higher odds ratio of leakage compared with injection of 10 mL and 12 mL in 5-cm segments (P = .003). CONCLUSION: Injections with 22-gauge needles reduced the frequency of leakage, while 20 mL instilled in 5-cm segments increased the frequency of leakage in intact segments of porcine jejunum. CLINICAL SIGNIFICANCE: Injection with a smaller syringe size attached to a 22-gauge needle through a 10-cm segment of small intestine may lower the frequency of leakage from the injection site, but influence on the detection of surgical site leakage remains unknown.

Influence of 2 Veress needles and 4 insertion sites on Veress needle penetration depth: A comparative study in cadaveric dogs.

OBJECTIVE: To evaluate the penetration depth (VNPD) of 2 disposable Veress needles (VN) at 4 insertion sites in the abdomen. STUDY DESIGN: Descriptive study. SAMPLE POPULATION: Canine cadavers (n = 22, 6 for confirmation of the test methods and 16 for the comparative study). METHODS: Two disposable VN (VN A and VN B) were inserted at 4 sites (9th intercostal space [ICS] and preumbilical, paraumbilical, and subumbilical sites) in dorsally recumbent dogs by using a hand-cranked jig. The VNPD was measured as the distance traveled by the VN between the subcutaneous tissue and the perforation of the peritoneum on the basis of audible clicks and visible feedback from the VN. The effects of the VN type and insertion site on the VNPD were analyzed by using a linear mixed-effects model. RESULTS: VNPD varied between insertion sites (P = .01) and VN (P < .01). The VNPD was less at the 9th ICS than at the preumbilical, paraumbilical, and subumbilical sites. The maximal magnitude of change was 7.4 mm. Veress needle B (with a low spring rate, lower forces, and a back-cut bevel design) penetrated farther than VN A (with a high spring rate, high forces, and a lancet-type bevel) at 3 of 4 insertion sites. The maximal magnitude of change was 6.8 mm. CONCLUSION: Veress needle penetration depth varied between VN designs but was the least at the 9th ICS in canine cadavers. CLINICAL SIGNIFICANCE: Insertion of a VN at the 9th ICS is recommended to minimize its penetration into the abdomen. Associations between VNPD and mechanical factors, such as the sharpness and spring rate of VN, warrant additional research.

Assessing the sharpness of hypodermic needles after repeated use.

Four gauges (14G, 16G, 18G, 20G) of single use hypodermic needles were evaluated for sharpness by measuring the force required to puncture rehydrated bovine leather. The needles began to dull after 1 use with maximum bluntness occurring within 4 to 5 uses.

Évaluation du tranchant des aiguilles hypodermiques après un usage répété. Quatre gabarits (14G, 16G, 18G, 20G) d'aiguilles hypodermiques à usage unique ont été évalués pour le tranchant en mesurant la force requise pour percer du cuir bovin réhydraté. Les aiguilles ont commencé à s'émousser après 1 usage et la capacité de tranchant maximale se produisait durant les 4 ou 5 premières utilisations.(Traduit par Isabelle Vallières).

COMPARISON OF ULTRASOUND-GUIDED VS. STANDARD LANDMARK TECHNIQUES FOR TRAINING NOVICE OPERATORS IN PLACING NEEDLES INTO THE LUMBAR SUBARACHNOID SPACE OF CANINE CADAVERS.

The standard technique for placing a needle into the canine lumbar subarachnoid space is primarily based on palpation of anatomic landmarks and use of probing movements of the needle, however, this technique can be challenging for novice operators. The aim of the current observational, prospective, ex vivo, feasibility study was to compare ultrasound-guided vs. standard anatomic landmark approaches for novices performing needle placement into the lumbar subarachnoid space using dog cadavers. Eight experienced operators validated the canine cadaver model as usable for training landmark and ultrasound-guided needle placement into the lumbar subarachnoid space based on realistic anatomy and tissue consistency. With informed consent, 67 final year veterinary students were prospectively enrolled in the study. Students had no prior experience in needle placement into the lumbar subarachnoid space or use of ultrasound. Each student received a short theoretical training about each technique before the trial and then attempted blind landmark-guided and ultrasound-guided techniques on randomized canine cadavers. After having performed both procedures, the operators completed a self-evaluation questionnaire about their performance and self-confidence. Total success rates for students were 48% and 77% for the landmark- and ultrasound-guided techniques, respectively. Ultrasound guidance significantly increased total success rate when compared to the landmark-guided technique and significantly reduced the number of attempts. With ultrasound guidance self-confidence was improved, without bringing any significant change in duration of the needle placement procedure. Findings indicated that use of ultrasound guidance and cadavers are feasible methods for training novice operators in needle placement into the canine lumbar subarachnoid space.

Microneedling as a successful treatment for alopecia X in two Pomeranian siblings.

BACKGROUND: Alopecia X (hair cycle arrest) is a relatively frequent hair growth disorder in Pomeranians and several other breeds, characterized by symmetrical, noninflammatory alopecia without systemic signs. The cause and pathogenesis remain unknown. Previously reported treatments with various topical and systemic drugs have been variably successful. HYPOTHESIS: We hypothesized that superficial mechanical skin trauma applied with a microneedling device would induce long-term hair regrowth at treated sites. ANIMALS: Two neutered female Pomeranian siblings with histologically confirmed alopecia X. Previous treatments with deslorelin, melatonin and topical minoxidil had failed to produce significant hair regrowth. METHODS: The dogs were anaesthetized and the skin was punctured with a microneedling device. Dogs were followed over a period of 12 months. RESULTS: Five weeks after microneedling hair regrowth started, followed by a reduction in hyperpigmentation of affected skin. After 12 weeks there was a 90% improvement in coat coverage at previously alopecic areas. Twelve months after the procedure, coat conditions remained stable. No adverse effects were noted. CONCLUSIONS AND CLINICAL IMPORTANCE: This is the first report of microneedling to induce hair regrowth in dogs affected by alopecia X. Long-term studies with microneedling in a larger number of dogs with alopecia X will need to be performed to confirm these preliminary results and to further evaluate if hair-regrowth is permanent.

Effect of needle brand, needle bevel grind, and silicone lubrication on contamination of joints with tissue and hair debris after arthrocentesis.

OBJECTIVE: To assess contamination of joints with tissue and hair debris after arthrocentesis. STUDY DESIGN: Experimental. ANIMALS: Fetlock joint tissues (n = 6 horses). METHODS: Soft tissue flaps including joint capsule were dissected from the dorsal aspect of fetlock joints of 6 anesthetized horses leaving an intact proximal base ("live" model) or with complete excision and immediate mounting to a wooden frame ("fresh" model). Needles were inserted through joint tissues and saline solution was flushed through them into tissue culture plate wells, and then examined for tissue and hair debris. Nine needle types were assessed; variables included needle brand, needle bevel grind, needle size, and silicone lubrication. RESULTS: No significant difference was detected between "live" and "fresh" models for hair or tissue contamination. Compared to 20 g hypodermic needles, 19 g lubricated and 19 g non-lubricated needles had a significantly greater odds ratio (OR) for hair contamination. Nineteen-gauge non-lubricated needles had a significantly greater OR for hair contamination than 19 g lubricated needles. No significant differences in ORs were identified between type of needle bevel grind, brands of disposable hypodermic needles, or brands of spinal needles for hair or tissue contamination. CONCLUSIONS: Nineteen-gauge needles significantly increase the risk of joint contamination with hair compared to 20 g needles; non-lubricated 19 g needles have the greatest risk. All other needle types tested in this study have similar risks for tissue and hair contamination after arthrocentesis.

Feasibility of ultrasound-guided epidural access at the lumbo-sacral space in dogs.

Epidural injections are commonly performed blindly in veterinary medicine. The aims of this study were to describe the lumbosacral ultrasonographic anatomy and to assess the feasibility of an ultrasound-guided epidural injection technique in dogs. A cross sectional anatomic atlas of the lumbosacral region and ex vivo ultrasound images were obtained in two cadavers to describe the ultrasound anatomy and to identify the landmarks. Sixteen normal weight canine cadavers were used to establish two variations of the technique for direct ultrasound-guided injection, using spinal needles or epidural catheters. The technique was finally performed in two normal weight cadavers, in two overweight cadavers and in five live dogs with radiographic abnormalities resulting of the lumbosacral spine. Contrast medium was injected and CT was used to assess the success of the injection. The anatomic landmarks to carry out the procedure were the seventh lumbar vertebra, the iliac wings, and the first sacral vertebra. The target for directing the needle was the trapezoid-shaped echogenic zone between the contiguous articular facets of the lumbosacral vertebral canal visualized in a parasagittal plane. The spinal needle or epidural catheter was inserted in a 45° craniodorsal-caudoventral direction through the subcutaneous tissue and the interarcuate ligament until reaching the epidural space. CT examination confirmed the presence of contrast medium in the epidural space in 25/25 dogs, although a variable contamination of the subarachnoid space was also noted. Findings indicated that this ultrasound-guided epidural injection technique is feasible for normal weight and overweight dogs, with and without radiographic abnormalities of the spine.

Efficacy of needle-free injection on antibody production against Clostridium chauvoei in beef calves under field conditions.

This study compared needle-free and needle-based injection devices for vaccination of calves against Clostridium chauvoei in warm and cold conditions. Both devices elicited comparable antibody responses in calves. Needle-free injection devices can be used to vaccinate calves provided appropriate precautions are taken in cold weather.

Efficacité de l'injection sans seringue sur la production d'anticorps contreClostridium chauvoeichez les veaux de boucherie dans des conditions sur le terrain. Cette étude a comparé les dispositifs à injection sans seringue et avec seringue pour la vaccination des veaux contre Clostridium chauvoei dans des conditions par temps chaud et froid. Les deux dispositifs ont provoqué des réponses comparables des anticorps chez les veaux. Des dispositifs d'injection sans seringue peuvent être utilisés pour vacciner les veaux pourvu que des précautions appropriées soient prises par temps froid.(Traduit par Isabelle Vallières).

Diagnostic stifle joint arthroscopy using a needle arthroscope in standing horses.

OBJECTIVE: To assess use of an 18 g arthroscope for diagnostic stifle joint examination in the standing horse. STUDY DESIGN: Phase 1 used cadaver limbs and simultaneous ultrasonographic assessment. Phase 2 used 6 normal horses where stifles were assessed in both a standing and flexed position. Phase 3 used horses with suspected stifle injury or disease. ANIMALS: Normal horses (n = 6) to assess ability to perform diagnostic procedure (phase 2) and 3 clinical cases (phase 3). METHODS: Five cadaver limbs were used in phase 1 to assess all stifle joints. Phase 2 used standing sedated and locally anesthetized horses. Routine arthroscopic approaches were used in both weight bearing and flexed nonweight bearing positions. In both phase 1 and 2 simultaneous ultrasonographic and arthroscopic examinations were used to confirm extent of diagnostic examination. The methods developed in phase 2 were used to examine the stifle in 3 horses with suspected stifle disease. RESULTS: In cadaveric limbs and horses, all intra articular structures that constitute a complete arthroscopic examination were identified; no intra -or postoperative morbidity occurred. In phase 3, the needle arthroscope was used in accurate identification of pathologic change and in 1 horse, an osteochondral fragment not detected by ultrasonography and radiography was identified. CONCLUSIONS: This preliminary work indicates that an 18 g arthroscope can be used for diagnostic examination of the equine stifle in standing horses.

Fragmented acupuncture needle as a linear metallic foreign body near the proximal interphalangeal joint of a horse.

OBJECTIVE: To describe the clinical presentation, diagnosis, and treatment of a fragmented, migrating acupuncture needle near the palmar proximal interphalangeal joint (PIPJ) of a horse. ANIMAL: A 9-year-old Warmblood cross mare. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES: The mare presented for evaluation of a linear metallic foreign body on the palmar lateral aspect of the PIPJ following acupuncture treatment. The mare had a pinpoint puncture wound and sensitivity to palpation over the lateral aspect of the PIPJ region. The referring veterinarian performed radiographs and found a linear metallic foreign body near the lateral palmar PIPJ. Ultrasonographic examination demonstrated a hyperechoic lesion consistent with a metallic object in the soft tissues of the palmar lateral aspect of the PIPJ. TREATMENT AND OUTCOME: The horse was anesthetized, and the linear metallic foreign body was removed. The use of intraoperative ultrasound and digital radiographs assisted in determining the location of and surgical approach to remove the foreign body. The linear metallic foreign body was the fragmented segment (body) of an acupuncture needle. The mare recovered from surgery uneventfully and returned to the previous level of activity. CLINICAL RELEVANCE: This report demonstrates the potential risks of prolonged retention and or delayed removal of acupuncture needles in the form of needle fragmentation and migration. It also demonstrates the use of imaging in determining the location and position of small, thin metallic foreign bodies to aid in surgical approach and removal.

Diagnostic accuracy of tissue impedance measurement interpretation for correct Veress needle placement in feline cadavers.

OBJECTIVE: To determine the diagnostic accuracy of tissue impedance measurement interpretation (TIMI) for determining correct versus incorrect Veress needle placement in feline cadavers. STUDY DESIGN: Prospective, randomized, blinded trial. STUDY POPULATION: Cat cadavers (n = 24). METHODS: Two laparoscopists (1 experienced, 1 novice), blinded to TIMI, placed reusable Veress needles in study subjects in a randomized order. A third individual interpreted impedance measurements as consistent with correct versus incorrect placement. Veress needle tip locations were marked by injecting contrasting colors of India ink. Tissue dissection was performed to localize ink. Sensitivity, specificity, accuracy, precision, and kappa statistics for TIMI for placements by the experienced and novice laparoscopist were determined. P < .05 was considered significant. RESULTS: TIMI identified 36/38 correct and 2/10 incorrect placements. TIMI identified 2/2 bowel perforations but was unable to identify 8 inappropriate placements in the retroperitoneal fat pad. Impedance measurement interpretation had 94.7% sensitivity, 20% specificity, 79.2% accuracy, and 81% precision overall. Agreement between TIMI and Veress needle location was absent (kappa = -0.15, P = .01) for placements by the experienced laparoscopist and substantial (kappa = 0.78, P < .01) for the novice laparoscopist. CONCLUSIONS: Failure of TIMI to identify placement in the retroperitoneal fat pad resulted in poor accuracy. Small cat size limited the number of appropriate placement sites, perhaps resulting in excessively dorsal placements. Use of TIMI may increase detection of clinically significant inappropriate Veress needle placements, like bowel perforations, and decrease installment phase complications. Further evaluation of Veress needle placement with and without TIMI is warranted.

Diagnostic accuracy of tissue impedance measurement interpretation for correct Veress needle placement in canine cadavers.

OBJECTIVE: To establish the diagnostic accuracy of tissue impedance measurement interpretation (TIMI) for determining correct versus incorrect Veress needle placement. STUDY DESIGN: Prospective, randomized, blinded trial. STUDY POPULATION: Canine cadavers (n = 20). METHODS: Two laparoscopists (1 experienced, 1 novice), blinded to tissue impedance measurement results, placed reusable Veress needles in canine cadavers in a randomized order. A 3rd individual interpreted impedance measurements as consistent with correct or incorrect Veress needle placement. Veress needle tip locations were marked by injecting contrasting colors of India ink. Tissue dissection was performed to localize ink. Sensitivity, specificity, accuracy, precision, and kappa statistics for TIMI for placements by the experienced and novice laparoscopist were determined. P < .05 was considered significant. RESULTS: TIMI identified 29/33 correct and 7/7 incorrect placements, respectively. Impedance measurement interpretation had 87.9% sensitivity, 100% specificity, 90% accuracy, and 100% precision overall. Agreement between TIMI and Veress needle location was moderate (kappa 0.50, P = .01) for placements by the experienced laparoscopist and very high (kappa 0.88, P < .01) for the novice laparoscopist. CONCLUSIONS: Diagnostic accuracy of TIMI for Veress needle placement was higher than has been reported for other tests, and TIMI had a shallow learning curve. TIMI successfully detected all incorrect Veress needle placements. Further prospective evaluation of Veress needle placement with and without TIMI is warranted to determine if its use increases operator detection of inappropriate Veress needle placements or decreases installment phase complication rates.

Use of needle enhancing software to improve injection technique amongst inexperienced anaesthetists performing ultrasound-guided peripheral nerves blocks in dogs.

OBJECTIVE: To determine if the use of needle enhancing software facilitate injection technique in ultrasound-guided peripheral nerve blocks. STUDY DESIGN: Prospective, blinded, randomized controlled trial. ANIMALS: Eight hind limbs from canine cadavers. METHODS: The limbs were randomly allocated to two groups; software on (group I) and software off (group II). Eight anaesthetists with no previous experience of ultrasound-guided regional anaesthesia were recruited. Thirty-six procedures were carried out (18 per group). After sciatic nerve visualisation via ultrasonography, the anaesthetist introduced a needle guided by ultrasonography. When the tip of the needle was considered by the anaesthetist to be as close as possible to the nerve without touching it, 0.05 mL of methylene blue dye was injected. Parameters evaluated included: number of attempts to visualise the needle with ultrasonography, time spent to perform the technique, subjective evaluation of ease of needle visualisation, proximity of the tip of the needle to the nerve, and, at dissection of the leg, inoculation site of the dye in relation to the nerve. RESULTS: Significant differences between groups were identified in relation to the number of attempts (group I: median 1, IQR: 1 - 1 attempts versus group II: median 1, IQR: 1 - 4 attempts, p = 0.019), and the relationship between the dye and the nerve during hind limb dissection (72.2% of the nerves were stained in group I versus 16.6% in group II, p = 0.003). No significant difference between groups was observed with respect to the time taken to perform the procedure (group I: median 25.5, IQR: 18.4 - 44.3 seconds versus group II: median 35.7, IQR: 18.6-78.72 seconds, p = 0.31), subjective evaluation of the needle visualization (p = 0.45) or distance between the tip of the needle and the nerve as measured from the ultrasound screen (p = 0.23). CONCLUSIONS AND CLINICAL RELEVANCE: This study identified greater success rate in nerve staining when the needle enhancing software was used. The results suggest that the use of this technique could improve injection technique amongst inexperienced anaesthetists performing ultrasound-guided peripheral nerve blocks in dogs.

Peripheral nerve stimulation under ultrasonographic control to determine the needle-to-nerve relationship.

OBJECTIVE: To determine the needle-to-nerve distances during electrical nerve location in dogs at different currents and pulse duration using a peripheral nerve stimulator (PNS) under ultrasound control (US), and the minimal electrical thresholds (MET) necessary to obtain a motor response (MR) after achieving needle-to-nerve contact. STUDY DESIGN: Prospective in vivo experimental trial in a clinical setting ANIMALS: Thirty dogs, scheduled for locoregional anaesthesia of the sciatic nerve. METHODS: Needle-to-nerve distance was measured ultrasonographically after obtaining the MR of sciatic nerve with 2, 1 and 0.5 mA and pulse duration 0.1 ms (NS0.1). Thereafter the needle was placed in contact with the nerve and MET was determined. The procedure was repeated with 0.3 ms (NS0.3). Finally the needle was reintroduced to contact the sciatic nerve guided only by US, thus MET-US was determined. Data were analysed using Kruskal-Wallis or Mann-Whitney tests. RESULTS: Needle-to-nerve distances were greater when MR was obtained with 2 mA than with 1 and 0.5 mA at 0.1 and 0.3 ms. No significant differences were observed between the needle-to-nerve distances using 0.1 or 0.3 ms. The MET [median (range)] was 0.4 (0.18-1.3) mA in NS0.1, 0.32 (0.12-0.8) mA in NS0.3; while MET-US was 0.7 (0.32-1.5) mA. When the needle contacted the nerve, the MR achieved with currents below 0.3 mA was obtained in 17.2, 40 and 0% of cases using NS0.1, NS0.3 and US respectively. CONCLUSIONS AND CLINICAL RELEVANCE: The electrical current necessary to obtain a MR decreased as the needle moved towards the nerve. However when the needle tip contacted the nerve, an MR with low current intensity could not be obtained. Thus the absence of motor response at currents below 0.3 mA cannot rule out needle-epineurium contact. When ultrasound is combined with PNS, it is more important to assess the correct needle position than searching for an MR at low currents.

Manual rupture versus transvaginal ultrasound-guided aspiration of allanto-amniotic fluid in multiple pregnancies: a clinical approach to embryo reduction in dairy cattle.

To avoid the problems associated with twinning in dairy cattle, one of the embryos may be eliminated. This study compares the effect on pregnancy maintenance of two embryo reduction techniques, manual rupture (MR) and transvaginal ultrasound-guided aspiration (TUGA) of allanto-amniotic fluid, in Holstein-Friesian cows with multiple pregnancies. In the first experiment, 61 lactating cows bearing unilateral twins (n=27), bilateral twins (n=30) or triplets/quadruplets (n=4) were subjected to MR (n=45) or TUGA using a 17-G neddle (n=16) on day 28-34 of gestation. In 21 and 10 cows undergoing MR and TUGA embryo reduction, respectively, pregnancy loss occurred before day 90 (46.7 vs. 62.5%, P= 0.28). Through binary logistic regression, the type of pregnancy was identified as the only variable significantly affecting pregnancy maintenance (P=0.03). Based on the odds ratio, the risk of pregnancy loss was 4.1 times higher for unilateral twins than for bilateral twins (70.4 vs. 36.7%, respectively, P=0.01). No effect was detected on pregnancy maintenance of the technique used (P=0.17) or of the interaction technique by type of pregnancy (P=0.22). In the second experiment, a 22-G needle was used to perform TUGA on 22 lactating cows. The pregnancy loss rates were 44.4% (4/9), 18.2% (2/11) and 50% (1/2) for cows bearing unilateral twins, bilateral twins and triplets, respectively. The total pregnancy loss rate following TUGA using the 22-G needle tended to be lower than that using the 17-G needle (31.8 vs. 62.5%; P=0.06). Our results suggest that TUGA using a 22-G needle could be the method of choice to perform embryo reduction in cows carrying multiple pregnancies.