Multimodal analgesia protocol for pain management after total knee arthroplasty: comparison of three different regional analgesic techniques.

OBJECTIVES: To evaluate three different analgesic techniques, continuous epidural analgesia (EA), continuous intra-articular (IA) infusion analgesia and continuous femoral nerve block (FNB) in postoperative pain management, length of hospital stay (LOS), and time of patient mobilization after total knee arthroplasty (TKA). METHODS: Seventy-two patients undergoing TKA were randomly allocated into three groups according to the analgesic technique used for postoperative pain management. Group EA patients received epidural analgesia (control group), group IA received intra-articular infusion and group FNB received femoral nerve block. RESULTS: Upon analyzing the Numerical Rating Scale (NRS) scores at rest, at passive and active movement, up to 3 days postoperatively, we observed no statistically significant differences at any time point among the three groups. Similarly, no association among these analgesic techniques (EA, IA, FNB) was revealed regarding LOS. However, significant differences emerged concerning the time of mobilization. Patients who received IA achieved earlier mobilization compared to FNB and EA. CONCLUSIONS: Both IA and FNB generate similar analgesic effect with EA for postoperative pain management after TKA. However, IA appears to be significantly more effective in early mobilization compared to EA and FNB. Finally, no clinically important differences could be detected regarding LOS among the techniques studied.

New experimental rabbit animal model for cervical spondylotic myelopathy.

STUDY DESIGN: Cervical spondylotic myelopathy (CSM) represents the most commonly acquired cause of spinal cord dysfunction among individuals over 55 years old. The pathophysiology of the disease involves static and dynamic mechanical factors, which are the result of chronic degeneration. The clinical course of the disease remains unpredictable. In the past, many experimental animal models have been developed to study the cellular and molecular mechanisms underlining the pathophysiology of the disease. OBJECTIVES: To create a new animal model of CSM, which will reproduce the temporal course of the disease and the local microenvironment at the site of spinal cord compression. METHODS: We performed posterior laminectomy to New Zealand rabbits at the level of C7, and a thin sheet (5-7 µm) of aromatic polyether was implanted with microsurgical technique at the epidural space underneath C5-C6 laminae. Motor function evaluation was performed after the operation and once a week thereafter. RESULTS: After 20 weeks, the animals were killed, and the histological evaluation of spinal cord at the site of compression above and below it, using eosin hematoxylin, immonohistochemistry and Kluver-Barrera techniques reveals axonal swelling and demyelination, interstitial edema and myelin sheet fragmentation. Moreover, histological evaluation of C5 and C6 laminae reveals osteophyte formation. CONCLUSION: We believe that this CSM model reproduces the temporal evolution of the disease and creates a local microenvironment at the site of spinal cord compression, which shares the same characteristics with that of human disease.

First report of fatal autochthonous angiostrongylosis in a dog in Greece.

Canine angiostrongylosis caused by Angiostrongylus vasorum is a life-threatening disease which is emerging in regions of Europe. Thus, there is the merit for a continuous epidemiological surveillance in dog populations. This is the first description of a clinical autochthonous case of canine angiostrongylosis in Greece. A 7-month-old, male, mixed-breed dog was presented with progressively worsening anorexia, respiratory distress, coughing, bleeding diathesis and succumbed four days post admission. Gross post mortem examination revealed numerous nodular fistulated lesions in the lungs, and pulmonary cytology and histopathology showed a verminous pyogranulomatous pneumonia. The definitive diagnosis was based on the morphological identification of first stage larvae (L1) retrieved in the feces by the Baermann method, the detection of the circulating antigen by an in-clinic test and the molecular identification of L1. This report underlines the epidemiological and clinical implications, as well as the infection risks when the index of clinical suspicion is low and the disease is unexpected in a country.

Effects of allopurinol treatment on the progression of chronic nephritis in Canine leishmaniosis (Leishmania infantum).

Forty dogs with canine leishmaniosis (CL) participated in this study, which was designed to investigate the effect of allopurinol on the progression of the renal lesions associated with this disease. The animals were allocated into 5 groups. Group A dogs (n = 12) had neither proteinuria nor renal insufficiency, group B dogs (n= 10) had asymptomatic proteinuria, and group C dogs (n = 8) were proteinuric and azotemic. Two more groups, CA and CB, comprising 5 dogs each, served as controls for groups A and B, respectively. Group A, B, and C dogs received allopurinol PO (10 mg/kg q12h) for 6 months, whereas group CA and CB dogs were placebo-treated. Serum biochemistry profile, urinalysis, urine protein/creatinine ratio, and glomerular filtration rate (GFR) measurements were carried out at the beginning of the study, the 3rd month, and the 6th month, whereas renal biopsies were carried out only at the beginning and the end of the trial. Membranoproliferative glomerulonephritis was the most common cause of chronic renal failure. Mesangioproliferative and tubulointerstitial nephritis were detected even in group A and CA dogs. Allopurinol not only lowered proteinuria in group B dogs but also prevented the deterioration of GFR and improved the tubulointerstitial, but not the glomerular, lesions in both group A and group B dogs. Further, it resolved the azotemia in 5 of the 8 dogs admitted with 2nd stage chronic renal failure (group C). Consequently, treatment with allopurinol is advisable in CL cases with asymptomatic proteinuria or 1st-2nd stage chronic renal failure.

A retrospective study of presentation, treatment, and outcome of free-ranging raptors in Greece (1997-2000).

A retrospective study was conducted on free-ranging raptors (n = 402) presented to the Veterinary Medical Teaching Hospital, School of Veterinary Medicine, Aristotle University of Thessaloniki, Greece, during a 3-yr period (1997-2000). Representatives of 19 species were admitted from taxonomic orders Accipitriformes (n = 295), Falconiformes (n = 35), and Strigiformes (n = 72). Traumatic injuries (n = 305, 75.8%) were the most common cause of presentation in all raptors. Starvation (n = 38 birds, 9.4%) was the second most common reason, whereas toxicoses (n = 28, 6.9%) were suspected in a limited number of birds. Orphans (n = 31, 7.7%) were presented during breeding season primarily because of inappropriate human intervention. Surgical and medical treatment was given to all birds when necessary. In total, 229 (56.9%) of the presented raptors were successfully rehabilitated and released, 121 (30%) were rehabilitated but nonreleasable, whereas 52 (12.9%) of them died despite treatment. Human intervention (79.2%) plays the most important role in birds of prey morbidity and mortality.

Effect of locally injected autologous platelet-rich plasma on second intention wound healing of acute full-thickness skin defects in dogs.

OBJECTIVES: Second intention wound healing may be impaired by wound and host factors and thus more advanced therapies are required for a fast and satisfactory outcome. Platelet-rich plasma (PRP), rich in growth factors and cytokines essential for tissue repair, could improve wound healing. The purpose of this experimental study was to evaluate the effect of locally injected autologous PRP on second intention healing of acute full-thickness skin defects in dogs. METHODS: Three 2 x 2 cm full-thickness skin defects were created bilaterally on the dorsolateral area of the trunk of six Beagle dogs. The wounds of one randomly selected side received PRP treatment, whereas the contralateral wounds were left untreated (controls). Wound healing was evaluated by planimetry, laser-Doppler flowmetry measurements of tissue perfusion, and histologically. RESULTS: The rate of wound healing did not differ significantly between the two groups. Tissue perfusion was significantly higher in the PRP-treated group (p = 0.008) compared to controls on day 10. Histological evaluation revealed a trend towards greater collagen production and a significantly better collagen orientation (p = 0.019) in PRP-treated wounds on day 20. CLINICAL SIGNIFICANCE: Locally injected autologous PRP does not accelerate the healing process, but increases tissue perfusion and may promote the formation of organized collagen bundles in acute full-thickness skin defects in dogs.

Ultrasonographic findings of intestinal intussusception in seven cats.

The medical records of seven cats with intestinal intussusception that were diagnosed by abdominal ultrasonography and exploratory laparotomy were reviewed. In transverse ultrasonographic sections the intussusception appeared as a target-like mass consisting of one, two or more hyperechoic and hypoechoic concentric rings surrounding a C-shaped, circular or non-specific shaped hyperechoic centre. Part of the intestine representing the inner intussusceptum, located close to the hyperechoic centre and surrounded by concentric rings, was also detected. In longitudinal sections the intussusception appeared as multiple hyperechoic and hypoechoic parallel lines in four cases and as an ovoid mass in three cases. In one case the ovoid mass had a 'kidney' configuration. Additional ultrasonographic findings associated with intestinal intussusception included an intestinal neoplasm in one cat. The results of the present study demonstrate that the ultrasonographic findings of intestinal intussusception in cats bear some similarities to those described in dogs and humans, are relatively consistent, and facilitate a specific diagnosis.

Locally injected autologous platelet-rich plasma enhanced tissue perfusion and improved survival of long subdermal plexus skin flaps in dogs.

OBJECTIVES: Distal flap necrosis remains a major complication in subdermal plexus (random) skin flaps. Platelet-rich plasma (PRP) has been shown to improve the survival of ischemic random skin flaps in rats. The objective of this study was to evaluate the effect of locally injected autologous PRP on the survival of long (5:1 length-to-width ratio) subdermal plexus skin flaps in dogs. METHODS: A 2x10 cm subdermal plexus skin flap was created bilaterally on the abdominal wall of six Beagle dogs. One randomly selected side received 2.5 ml of fresh auto-logous PRP injected evenly between sutures underneath the flap, whereas the other side was left untreated (control). Skin flap survival was evaluated macroscopically, histologically and by laser-Doppler flowmetry measurements of tissue perfusion. RESULTS: Flap percentage survival on day 10 (96.3% versus 74.5%; p = 0.046) and tissue perfusion (p <0.036) were significantly higher in PRP-treated flaps compared with controls. Histologically, there was less oedema in PRP-treated flaps compared to controls (p = 0.01), whereas collagen production and angiogenesis did not differ significantly between the two groups. CLINICAL SIGNIFICANCE: The use of locally injected autologous PRP increases tissue perfusion and improves the survival of long subdermal plexus skin flaps in dogs.

Evaluation of aqueous tear production in dogs after general anaesthesia with medetomidine-propofol-carprofen-halothane.

The influence of an anaesthetic protocol, which included medetomidine, propofol, carprofen and halothane on tear production in the dog. There are no previous studies on the effects of this combination on tear production in dogs or in any other species. The present study included 39 dogs, which underwent non-ophthalmic surgery in our clinic. Preanaesthetically, all dogs had normal tear production (18.62±3.65 mm/minute) as this was recorded with Schirmer tear test I (STT I) and the ophthalmologic examination did not reveal anything abnormal. Tear production readings were recorded before the administration of premedication, at the end of anaesthesia, one hour and two hours postanaesthesia. No reverse agent was administrated. At the end of anaesthesia (right eye (oculus dexter, OD) P<0.0005, left eye (oculus sinister, OS) P<0.0005), as well as one hour postanaesthesia (OD P=0.020, OS P=0.001) there was a statistically significant reduction in tear production, which returned to normal values two hours postanaesthesia, regardless of the duration of the operation. This anaesthetic combination resulted in a decrease in tear production and, therefore, the use of tear substitute treatment in dogs undergoing anaesthesia with this protocol (combination) from the time the sedative is given until at least two hours after the end of anaesthesia is highly recommended.

Surgical treatment of gastric impaction in farmed ostriches.

Partial or complete impaction of the proventriculus and/or the ventriculus is usually seen in juvenile ostriches. Common impaction materials include stones, sand, hay stems and leaves, and even plastic and metallic objects. Six live ostriches showing signs of impaction and three dead ones suspected to have impacted stomachs were presented to the Department of Clinical Sciences of the Faculty of Veterinary Medicine of the Aristotle University of Thessaloniki. The birds manifested anorexia, whitish and decreased urine output, scant defecation, unwillingness to rise and consume water. Clinical examination revealed distended and firm proventriculi, while radiographs showed foreign objects in the proventriculi of all birds and the ventriculus of one of them. The living birds were successfully treated surgically and medically. Autopsy of the three dead ostriches revealed severe dehydration and impaction of the stomachs. Bacteriological and parasitological examination was negative. Amendments in management practices were important to minimize losses caused by impaction of the stomachs in ostriches, while proventriculotomy remains the most effective approach to the problem.