Arthroscopic anatomy of the equine temporomandibular joint.

OBJECTIVE: To develop an arthroscopic approach to, and describe the arthroscopic anatomy of, the equine temporomandibular joint (TMJ). STUDY DESIGN: Cadaveric study, after which the technique was tested in horses. ANIMALS OR SAMPLE POPULATION: Ten cadaveric equine heads and 5 normal horses (age, 5-13 years; weight, 425-545 kg). METHODS: Specimens or horses were positioned in right lateral recumbency. After fluid distention of the TMJ, arthroscopic portals were made in the dorsal compartment over the most prominent portion of the joint outpouching (caudodorsal approach) and in rostral and intermediate locations. The joint was explored and photographed. Positional changes in the mandible were made to determine if observation of the joint could be improved. Instrument portals were created to assess the feasibility of surgical arthroscopy. Cadaveric heads were dissected to assess iatrogenic damage, whereas experimental horses were observed for postoperative complications for 30 days. RESULTS: A caudodorsal arthroscopic approach provided the best evaluation of the dorsal compartment of the TMJ. The approach allowed observation of the rostral and caudal synovial pouches and the lateral aspect of the joint including the articular disc. Examination of the medial aspect of the joint was limited to the most rostral and caudal aspects. Access to the lateral aspect of the ventral compartment of the TMJ was precluded by the position of the transverse facial artery and vein. In specimens, iatrogenic damage was minimal and limited to the articular fibrocartilage, articular disc, and penetration of the parotid salivary gland. If the latter also occurred in horses, no adverse effects were noted. In horses, mild fluid extravasation occurred and resolved within 1 day. All horses ate normally after surgery but had periarticular swelling and mild pain upon palpation of the TMJ for 2 days. CONCLUSIONS: A caudodorsal arthroscopic approach to the TMJ allowed adequate observation of the lateral aspect of the dorsal compartment of the joint. Access to the ventral compartment was precluded by the location of the transverse facial artery and vein. CLINICAL RELEVANCE: Conditions affecting the lateral and caudal aspects of the dorsal compartment of the TMJ should be visible by arthroscopy.

Failure of holmium:yttrium-aluminum-garnet laser lithotripsy in two horses with calculi in the urinary bladder.

Holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripsy was attempted in a mare and a gelding with calculi in the urinary bladder. The procedure was unsuccessful in producing adequate fragmentation of the calculi. In the gelding, pulsed dye laser lithotripsy was subsequently used to fragment the urolith. Manual removal of the urolith via the urethra was performed in the mare.

Impact of prescribed activity restriction during pregnancy on women and families.

Using grounded theory, I examined the experience of women and their families of prescribed activity restriction during pregnancy for treatment of preterm labor. The major finding in this study suggests that women and their families see themselves as "doing the best we can" as they attempt to balance the demands of activity restriction and the needs of individuals and the family. Invariably, maternal activity restriction resulted in increased emotional distress and, in some cases, family disruption. Those who succeeded in establishing a balance between these competing demands saw themselves as "doing okay" and found the emotional distress and family disruption to be manageable. In contrast, those who had difficulty balancing competing demands described themselves as "on the edge" and experienced uncomfortable levels of emotional distress and, occasionally. significant disruptions to the family. Conditions associated with these two modes of functioning, as well as consequences of this experience for women and their families, are identified.

Small intestine strangulation by components of the spermatic cord in two geldings.

Two adult Quarter Horse geldings were evaluated for signs of abdominal pain. Both horses had signs of depression and distended small intestines on abdominal palpation per rectum. Abdominal exploratory surgery was performed on both horses. In each instance, small intestine was found to be strangulated by components of the spermatic cord. Both horses were euthanatized because of a poor prognosis. Although not commonly observed, incarceration of intestine by components of the spermatic cord should be considered as a cause of small intestine strangulation in male horses. Early recognition of this condition would have increased these horses' chances of survival.

Chyloperitoneum and abdominal adhesions in a miniature horse.

Chyloperitoneum is a potential cause of colic in horses. Although rare in horses, chyloperitoneum can develop secondary to tearing of mesenteric adhesions and rupture of mesenteric lymphatic vessels. The prognosis for horses with chyloperitoneum depends on the underlying cause and the response to treatment.

Urinary bladder marsupialization for treatment of obstructive urolithiasis in male goats.

OBJECTIVES: To describe a surgical procedure for urinary bladder marsupialization and to report the results obtained from its use in the treatment of obstructive urolithiasis in male goats. STUDY DESIGN: Retrospective evaluation. ANIMALS OR SAMPLE POPULATION: Male goats with obstructive urolithiasis. METHODS: Medical records of male goats that had urinary bladder marsupialization for the treatment of obstructive urolithiasis were reviewed. Data retrieved from the medical records included signalment, postoperative treatment, duration of hospitalization, and short-term and long-term complications. Median values for measured variables were calculated. RESULTS: A total of 18 of 19 goats survived. Urinary flow was re-established in all 19 goats at the conclusion of surgery. Short-term postoperative complications (bladder mucosal prolapse and death) were observed in 2 goats. Long-term postoperative complications (cystitis and fibrotic stomal closure) occurred in 2 animals. Median duration of hospitalization was 4 days. At the time of follow-up, mild urine scald was reported for all goats. Clinical signs of upper urinary tract disease or obstruction were not reported. A total of 15 of 17 owners were satisfied with the procedure. CONCLUSIONS: Urinary bladder marsupialization provided long-term resolution of urinary outflow obstruction in all goats with acceptable morbidity. CLINICAL RELEVANCE: Urinary bladder marsupialization is a procedure that provides a good prognosis for long-term resolution of obstructive urolithiasis in male goats.

Evaluation of mild lameness in horses trotting on a treadmill by clinicians and interns or residents and correlation of their assessments with kinematic gait analysis.

OBJECTIVE: To estimate sensitivity and accuracy of subjective evaluation of mild lameness in horses during treadmill locomotion and to correlate subjective evaluation with kinematic analysis. ANIMALS: 19 lame and 5 clinically normal horses. PROCEDURE: Lameness was evaluated by subjective score and kinematic analysis before and after palmar digital nerve block (PDNB). Evaluations were made by 6 clinicians and 7 interns or residents. Within- and between-observer agreement analyses (kappa values) were calculated and compared, using a Student's t-test. Pearson's product-moment correlation coefficients were calculated between clinician's change in score and the change in kinematic variables after PDNB. RESULTS: Within-observer agreement was within the range expected for conditions of moderate diagnostic difficulty. Within-observer agreement was higher for clinicians than for interns or residents. Between-observer agreement was acceptable for scores within 1 value of each other. Between-observer agreement of change in lameness score after PDNB was poor. When kinematic variables were ranked with each clinician's subjective change in score, only 2 were among the top 3 for the majority of clinicians. Asymmetry of vertical head movement between contralateral forelimb stance phases and the point of maximum hoof height during swing decreased as lameness subjectively improved. CONCLUSION: Mild lameness may be difficult to evaluate during treadmill locomotion. Although clinicians were more repeatable in their subjective evaluation of lameness than interns or residents, they were not more reliable at detecting the true state of lameness. CLINICAL RELEVANCE: Lack of agreement between clinician scoring of mild lameness emphasizes the need to use more objective measures for quantifying lameness.

Pulsed dye laser lithotripsy for treatment of urolithiasis in two geldings.

Transendoscopic pulsed dye laser lithotripsy was effective in the treatment of calcium carbonate urothlithiasis in 2 adult geldings. Perineal urethrotomy provided convenient access for standing transendoscopic lithotripsy and evacuation of a large cystic calculus in one gelding. In the second horse, an obstructive urethral calculus was fragmented and removed by a transurethroscopic approach. Pulsed dye laser lithotriptor is effective in fragmentation of the most common form (calcium carbonate) of uroliths in horses and may be performed in standing horses with reduced surgical invasiveness and trauma to the urinary tract, compared with conventional approaches. The principle disadvantages include cost of the procedure, which is comparable to laparocystotomy, and the time delay required to make arrangements for use of the pulsed dye laser lithotriptor.

Effect of omentectomy on adhesion formation in horses.

OBJECTIVE: To determine if omentectomy would decrease the frequency of postoperative intraabdominal adhesions. STUDY DESIGN: Retrospective study. ANIMALS OR SAMPLE POPULATION: 44 horses that had either two ventral median celiotomies or a ventral median celiotomy and a necropsy more than 4 days later; 19 of these horses had their omentum removed at the initial surgery. METHODS: Data retrieved from the records included location and type of intraabdominal adhesions; location of the surgical lesion; relationship of adhesions to the surgical lesion; surgical procedures; duration of initial surgery; time interval between procedures; age, gender, and breed of the horse; and clinical outcome. Fisher's exact test was used to evaluate the association between categorical explanatory and outcome variables. The effect of potential risk factors on the incidence rate of adhesion formation was estimated using a proportional hazards regression model. RESULTS: Of 25 horses in the nonomentectomy group, 15 (60%) had postoperative adhesions that resulted in the need for a second surgical intervention, whereas of 19 horses that had omentectomy initially, only 4 (21%) had postoperative adhesions that required a second procedure. Rate of adhesion formation was higher in horses that did not have omentectomy initially (incidence ratio rate [IRR], 0.46; 90% confidence interval [CI], 0.18 to 1.19). At initial surgery, 24 horses had a small intestinal lesion, and 20 horses had a large intestinal lesion. Fifteen horses (63%) with small intestinal lesions subsequently developed adhesions compared with four horses (20%) with an initial large intestinal lesion (P = .006). At the second procedure, small intestine lesions were identified in 32 horses and large intestine lesions in 12 horses (1 horse had both small and large intestine lesions), and 1 horse had a gastric lesion. Adhesions were identified as the cause of colic signs in 19 (61%) horses with small intestinal lesions and in none of the horses with large intestine lesions. The frequency of adhesion development leading to colic associated with only the small intestine at the second surgery or necropsy was significantly greater (P = .001) than the frequency only in the large intestine. CONCLUSIONS: Omentectomy reduced the rate of postoperative adhesion formation. Adhesions are more likely to occur after small intestinal surgery and if they do occur likely involve the small intestine. CLINICAL RELEVANCE: Omentectomy is a safe procedure and should be considered prophylactically for reduction of adhesion formation after abdominal surgery in horses.

Preparing nurse leaders for the future: views from Canada.

Preparing nurse managers for the present and nurse leaders for the future in the Canadian health care system is discussed from the perspective of service and education. The Canadian health care system is undergoing change, as the need to reduce and control costs comes in conflict with strongly held principles of the Canada Health Act. Nurse leaders will require knowledge and skill in transformative leadership to enable nurses to focus on the core of professional practice as clinical settings shift to self-directed, transdisciplinary teams. Nurse leaders also will need skills in building alliances within an increasingly consumer-controlled health care system, and competencies in work redesign and system design and redesign to enable nursing to smooth the "seams" in a high-functioning, but not necessarily well-integrated health care system. Judgment and clarity of vision are needed to embrace conflict when necessary and to prevent the initiation of practices and structures that run counter to the values embedded in the Canada Health Act, and nursing itself.

Facial shape and judgements of female attractiveness.

The finding that photographic and digital composites (blends) of faces are considered to be attractive has led to the claim that attractiveness is averageness. This would encourage stabilizing selection, favouring phenotypes with an average facial structure. The 'averageness hypothesis' would account for the low distinctiveness of attractive faces but is difficult to reconcile with the finding that some facial measurements correlate with attractiveness. An average face shape is attractive but may not be optimally attractive. Human preferences may exert directional selection pressures, as with the phenomena of optimal outbreeding and sexual selection for extreme characteristics. Using composite faces, we show here that, contrary to the averageness hypothesis, the mean shape of a set of attractive faces is preferred to the mean shape of the sample from which the faces were selected. In addition, attractive composites can be made more attractive by exaggerating the shape differences from the sample mean. Japanese and caucasian observers showed the same direction of preferences for the same facial composites, suggesting that aesthetic judgements of face shape are similar across different cultural backgrounds. Our finding that highly attractive facial configurations are not average shows that preferences could exert a directional selection pressure on the evolution of human face shape.

Impact of maternal activity restriction for preterm labor on the expectant father.

OBJECTIVE: To describe the impact on expectant fathers of their partners' activity-restricted pregnancies. DESIGN: Qualitative. SETTING: Private physician practices and two teaching hospitals in a large southern city. PARTICIPANTS: Self-selected sample of 15 fathers recruited within 2 weeks of initiation of their partners' activity restriction for high-risk pregnancy (phase 1) and 15 fathers recruited 1-2 years after a previous experience with their partners' activity-restricted pregnancies (phase 2). DATA COLLECTION: In phase 1, two semistructured interviews during the period of activity restriction and one interview after the birth. In phase 2, one semistructured, focus group interview. RESULTS: Fathers reported high levels of worrying immediately after diagnosis of their partners' preterm labor and initiation of activity restriction. Later, fathers also reported distress related to responsibility for child care, household management, and maintaining a supportive environment for their partners. Fathers reported few sources of personal support and little or no contact with health professionals during their partners' activity restriction. CONCLUSIONS: Activity restriction during pregnancy may have a significant psychological impact on expectant fathers. High levels of emotional distress may result in family disruption. Systematic nursing assessment and intervention may prevent or ameliorate distress.

Effect of stress on family functioning during pregnancy.

A theoretical model hypothesized to predict family functioning was tested in four groups of expectant parents, followed by exploratory model building. The groups studied during the 24th to 34th weeks of pregnancy included 153 high-risk hospitalized women, 75 of their partners, 218 low-risk women from the general obstetric clinic, and 147 of their partners. Both partners in the high-risk situation reported greater discrepancy in family functioning than partners in the low-risk situation. The hypothesized models proved to have low explanatory power, accounting for 13% to 15% of the variance. The final empirical models developed explained 33% of the variance in family functioning among high-risk women and 48% among their partners, 23% among low-risk women, and 32% among their partners. The empirical models differed from the hypothesized models in that variables postulated to have only indirect effects were shown to have direct effects on family function and inter-generational variables significantly expanded the theoretical model.