Clinical Assessment of an Ipsilateral Cervical Spinal Nerve Block for Prosthetic Laryngoplasty in Anesthetized Horses.

The nociceptive blockade of locoregional anesthesia prior to surgical stimulation can decrease anesthetic agent requirement and thereby potential dose-dependent side effects. The use of an ipsilateral second and third cervical spinal nerve locoregional anesthetic block for prosthetic laryngoplasty in the anesthetized horses has yet to be described. Anesthetic records of 20 horses receiving locoregional anesthesia prior to laryngoplasty were reviewed and compared to 20 horses of a similar patient cohort not receiving locoregional anesthesia. Non-blocked horses were 11 times more likely to require adjunct anesthetic treatment during surgical stimulation (P = 0.03) and were 7.4 times more likely to receive partial intravenous anesthesia in addition to inhalant anesthesia (P = 0.01). No horse in the blocked group received additional sedation/analgesia compared to the majority of non-blocked horses (75%) based on the anesthetist's perception of anesthetic quality and early recovery movement. No difference in recovery quality was observed between groups (P > 0.99). Cervical spinal nerve locoregional anesthesia appears well-tolerated and useful in reducing cumulative anesthetic agent requirement and may decrease the need for additional sedation/analgesia in horses undergoing anesthetized prosthetic laryngoplasty.

Effects of bilateral distal femoral stress in a patient on long-term pamidronate.

Recent studies have shown an association between long-term bisphosphonate therapy and low-energy subtrochanteric femoral fractures. These fractures have the unusual characteristics of occurring after a period of prodromal symptoms such as local pain, stress reaction, and low-energy transverse or oblique fractures in the subtrochanteric area of the femur. In this article, we present the case of a 62-year-old patient who was on pamidronate when she fell and sustained a femoral fracture resulting from bilateral stress phenomena in the distal third of the femoral shaft. Before the fracture, she had osteoporosis (confirmed with dual-energy x-ray absorptiometry) and prodromal symptoms in the right thigh. She also had left thigh pain radiating to the left knee, which was attributed to lower thigh pain from a prior diagnosis of osteoarthritis (OA) in the left knee. The femoral fracture healed with retrograde nail fixation, the left thigh pain resolved with prophylactic nail fixation, and pamidronate therapy was continued. Management options for femoral stress phenomena in patients on long-term bisphosphonates include discontinuation of the medication and prophylactic stabilization of the femur. Associated ipsilateral knee OA, present in our patient's case, may be a red herring in distal femoral stress phenomena.

Case report: A technique to remove a jammed locking screw from a locking plate.

BACKGROUND: Locking titanium plates revolutionized the treatment of osteoporotic and metaphyseal fractures of long bones. However as with any innovation, with time new complications are identified. One of the problems with titanium locking plates is removal of screws, often attributable to cold welding of screw heads into the locking screw holes. Several techniques have been described to overcome this problem. We describe a new easy technique to remove a jammed locking screw in a locking plate that is easily reproducible and suggest an algorithm to determine the method to remove screws from locking plates. CASE DESCRIPTION: A 57-year-old man underwent removal of a locking titanium plate from the distal femur. Because the screws could not be readily removed, we used a new technique to remove the jammed locking screws. A radial cut was made in the plate into the locking screw hole and wedged with an osteotome. This released the screw head from the locking screw hole. The screw holes were connected with radial cuts and jammed locking screws were removed in a similar fashion. LITERATURE REVIEW: Instruments used for removal of locking screws, including conical extraction screws, hollow reamers, extraction bolts, modular devices, and carbide drill bits, have been described. However, these do not always work. PURPOSES AND CLINICAL RELEVANCE: Removing screws from locking titanium plates can be difficult. There is no method of implant removal that can be universally applied. Therefore, this new technique and our algorithm may be used when removing screws from locking titanium plates.

Vitamin D and oestrogen receptor polymorphisms in developmental dysplasia of the hip and primary protrusio acetabuli--a preliminary study.

We investigated the association of developmental dysplasia of the hip (DDH) and primary protrusion acetabuli (PPA) with Vitamin D receptor polymorphisms Taq I and Fok I and oestrogen receptor polymorphisms Pvu II and Xba I. 45 patients with DDH and 20 patients with PPA were included in the study. Healthy controls (n = 101) aged 18-60 years were recruited from the same geographical area. The control subjects had a normal acetabular morphology based on a recent pelvic radiograph performed for an unrelated cause. DNA was obtained from all the subjects from peripheral blood. Genotype frequencies were compared in the three groups. The relationship between the genotype and morphology of the hip joint, severity of the disease, age at onset of disease and gender were examined. The oestrogen receptor Xba I wild-type genotype (XX, compared with Xx and xx combined) was more common in the DDH group (55.8%) than controls (37.9%), though this just failed to achieve statistical significance (p = 0.053, odds ratio = 2.1, 95% CI = 0.9-4.6). In the DDH group, homozygosity for the mutant Taq I Vitamin D receptor t allele was associated with higher acetabular index (Mann-Whitney U-test, p = 0.03). Pvu II pp oestrogen receptor genotype was associated with low centre edge angle (p = 0.07). This study suggests a possible correlation between gene polymorphism in the oestrogen and vitamin D receptors and susceptibility to, and severity of DDH. The Taq I vitamin D receptor polymorphisms may be associated with abnormal acetabular morphology leading to DDH while the Xba I oestrogen receptor XX genotype may be associated with increased risk of developing DDH. No such correlations were found in the group with PPA.

Cardiopulmonary effects of xylazine and acepromazine in pregnant cows in late gestation.

OBJECTIVE: To determine effects of sedation achieved by xylazine (XYL) or acepromazine (ACE) on cardiopulmonary function and uterine blood flow in cows in late gestation. ANIMALS: 8 cows between 219 and 241 days of gestation. PROCEDURE: Doses of ACE (0.02 mg/kg) or XYL (0.04 mg/kg) were administered IV. Measurements were obtained to determine cardiopulmonary effects and oxygen delivery to the uterus. RESULTS: Heart rate was not significantly affected by administration of ACE, but it decreased markedly after administration of XYL. Uterine artery flow was decreased at all times by XYL and was always less than for ACE. Xylazine increased uterine vascular resistance through 30 minutes and caused reduced PaO2 and increased PaCO2 at all time periods. Acepromazine caused a 5% decrease in PaO2 only at 5 minutes. Xylazine reduced oxygen delivery by 59% at 5 minutes and 32% at 45 minutes. In contrast, ACE caused a nonsignificant reduction of oxygen delivery by 16% at 15 minutes and a return to baseline values by 45 minutes CONCLUSIONS AND CLINICAL RELEVANCE: Xylazine markedly reduces flow and availability of oxygenated blood to the uterus, which may critically impair delivery of oxygen to the fetus at a stressful and important time of development or delivery. Acepromazine was associated with slight reductions of much shorter duration. When XYL is used to sedate pregnant cows, it could impose physiologic distress on the fetus and potentially increase fetal morbidity and mortality. When sedation of the dam is desirable, ACE could be an alternative to XYL.