[Two horses with neurological symptoms: could this be equine botulism?]. / Twee paarden met neurologische verschijnselen: is botulisme in het spel?

Symptoms, diagnosis and therapy of equine botulism are discussed by the presentation of two detailed reports of horses with neurological symptoms and the results of laboratory investigations over the period 2003-2008 in the Netherlands. In addition a brief summary of the available literature is presented. Prevailing symptoms of botulism in horses include paralysis of the tongue, salvation, dysphagia and paresis and paralysis of the skeletal muscles, as well as signs of colic. Symptoms and prognosis vary with the amount of botulinum neurotoxin (BoNT) involved. For early clinical diagnosis of botulism thorough investigation of the facial nerves is important, for instance by the use of the 'Tongue Stress Test'. Laboratory results often remain negative, probably due to the sampling time, the high sensitivity of horses for botulinum neurotoxin or treatment with antitoxins. Most clinical cases in horses are caused by botulinum neurotoxin B (BoNT/B). For therapy to be successful antiserum needs to be administered in the earliest possible stage of the disease and this should be supported by symptomatic therapy. Botulism is a feed-related intoxication caused by either carcasses in the roughage or BoNT/B production after poor conservation of grass silage. This is the main source of botulism in horses due to the popularity of individually packed grass silage as feed for horses. As long as no vaccine is available in the Netherlands quality control of silage and haylage is strictly recommended in order to reduce the risk of botulism in horses.

[Practical questions in case of maternal death]. / Questions pratiques en cas de survenue d'un décès maternel.

Every year, in France, about 70 women die during their pregnancy or the delivery. Any maternal death during labour is a traumatic event for the medical team and the family. The medical team has to face many "new" problems. We try to identify all the problems which the medical team has to face in front of a maternal death and try to solve them by a medical literature and French laws review. The medical team often feels powerless when a maternal death occurs. This work was made to be a guideline.

The Impact of Laparoscopic Surgery on Vaginal Hysterectomy

The development of laparoscopic surgery may be used either to replace (laparoscopic hysterectomy, LH) or to extend the indications (laparoscopically assisted vaginal hysterectomy, LAVH) of the vaginal route. A 2-year (March 1991-March 1993) prospective study of the impact of laparoscopic surgery has been carried out by a group of surgeons experienced in both vaginal and laparoscopic surgery. The design of the study protocol was as follows: use the vaginal route whenever possible; select LH in women with very narrow vaginal access or LAVH to improve the feasibility and safety of vaginal hysterectomy in case of adnexal disease; and select laparotomy only when both laparoscopic and vaginal surgery are impossible. Women with genital prolapse or pelvic relaxation were excluded as well as women with invasive malignant disease of the genital tract. Four hundred twenty-eight patients were included. Abdominal hysterectomy was used in only 44 cases (10.3%), including 4 cases of failure of the vaginal technique. Vaginal hysterectomy was completed without laparoscopic assistance in 339 (79.2%) of cases. LAVH was performed in 45 cases (10.5%), LH in 0. Laparoscopic surgery is an efficient modality for the vaginal surgeon in the presence of adnexal disease, but does not replace the less expensive, quicker and probably safer vaginal hysterectomy.

[The "hazards" of using a Gore-Tex sling in the treatment of stress urinary incontinence]. / Les "aléas" de l'utilisation d'une fronde de Gore-Tex dans le traitement de l'incontinence urinaire d'effort.

OBJECTIVE: To analyze the use of the Gore-Tex in the treatment of exertion incontinence. METHODS: During 1991, two gynecology units used the Mouchel technique and a Goebell-Stoeckel type technique in 72 patients with exertion incontinence, alone in 36 and in combination with a cure for prolapsus in 36 others. Results were analyzed with the chi 2 squared test and the Student's test for paired series. RESULTS: The rate of incontinence was 65% with a range from 60 to 66.7% according to the type of technique used and whether a cure for prolapsus was also performed. Gore-Tex was not well tolerated in 23/72 cases. Rejection was seen in 20 to 37.5% according to the type of vaginal suture and the type of protection. CONCLUSION: The high rate of rejection suggests prudence in using Gore-Tex.

[Results of tibial valgus osteotomy for internal femoro-tibial arthritis with an average 8-year follow-up]. / Devenir des ostéotomies tibiales valgisantes pour arthrose fémoro-tibiale interne avec un recul moyen de 8 ans.

One hundred and eighteen knees treated by valgus osteotomy for medial femorotibial osteoarthritis were reviewed with an average follow-up of 8 years (2-23 years). Seventy-four percent of the results were good and excellent after 5 years, 64% at 10 years and 61% after 10 years. The best results were observed in patients younger than 60 years, with femorotibial osteoarthritis not exceeding grade II of Ahlback's classification, and moderate femoropatellar osteoarthritis. The optimal final valgus observed was between 3 and 10 degrees. Four knees have been reoperated by arthroplasty.

[Ovarian cysts: strategy and prognosis]. / Kystes de l'ovaire: stratégie et pronostic.

The management of an adnexal masses involves several steps: establish the diagnosis of organic ovarian cyst, avoiding a useless and iatrogenic surgery of a functional cyst, knowing that functional cysts may persist more than 3 months and may occur even on low-dose oral contraceptives; cure painful cysts, by ultrasound guided aspiration of some functional cysts or laparoscopic detorsion of twisted adnexae; exclude malignancy, with the help of ultrasound, Doppler and Ca-125 preoperatively, then laparoscopic examination and pathology; failed diagnosis of cancer becomes rare (1 out of 300 laparoscopic surgeries for ovarian cyst); the association of a benign ultrasound and Doppler pattern and of a Ca-125 lower than 35 mUI/ml is almost pathognomonic of a benign cyst; cure benign ovarian cysts with a minimum of surgical trauma; in our series, 84.4% of ovarian cysts are managed laparoscopically, 11.1% by elective laparotomy, 4.5% by laparotomy after an attempt at laparoscopic surgery (that implies that the patient must be informed of the risk of laparotomy); adapt the surgical technique to the pathologic type and size of the cyst, with a high rate of laparotomy in large dermoid cysts, and a high rate of (salpingo-)oophorectomy in peri or postmenopausal cysts; ensure an adequate therapy of early ovarian carcinomas, avoiding understadification and undertreatment; prevent ovarian cancer by a careful long-term follow-up of patients with benign ovarian cysts and by the use of bilateral oophorectomy in postmenopausal patients.

Laryngotomy as a treatment for chronic laryngeal obstruction in cattle: a review of 130 cases.

One hundred and thirty cattle with chronic laryngeal obstruction were treated by surgery; the diagnostic and operative techniques are discussed. A simplified technique using local anaesthesia of the laryngeal area was used in sedated calves weighing up to 200 kg. Inhalation anaesthesia through a distal tracheotomy was needed in heavier animals. Complications related to the surgical intervention are described. The animals were reviewed from five months to over one year after discharge from the clinic. The long term survival rate of the 130 animals was 58 per cent. The results after surgery were excellent in 40.9 per cent and good in 15.2 per cent of the animals.

Cardiovascular effects of low dose calcium chloride infusions during halothane anaesthesia in dorsally recumbent ventilated ponies.

The effects of calcium chloride administered at low infusion rates on the cardiovascular depression and the blood calcium balance were studied during a constant halothane anaesthesia in dorsally recumbent ventilated ponies. A pronounced cardiopulmonary depression characterized by decreases of all cardiac parameters and lowering of the mean arterial blood pressure was observed after the initial anaesthetic stabilization period of 30 minutes in the ponies. A significant decrease in the total calcium plasma concentration together with a constant ionized and complexed calcium fraction was present after the stabilization period. Calcium chloride administration at different infusion rates (0.1, 0.2 and 0.3 mg/kg/min) induced a dose-dependent increase in mean systemic blood pressure, probably due to the observed increase in total peripheral resistance. A dose-dependent gradual decrease in heart rate, probably mediated by the increased vagal activity, was observed after the calcium infusions. The stroke volume increased also in a dose-dependent way. Cardiac output, arterial blood gases or packed cell volume were not influenced by the exogenous calcium infusions. The observed increases in mean pulmonary artery pressure and total pulmonary resistance were probably time-related responses. Overall, only the effects of the exogenous calcium on the peripheral vasculature, namely a vasoconstriction leading to an increase in blood pressure, were present in this study. Although LV dP/dt max was not measured in this study, minor positive inotropic effects of the exogenous calcium infusions might nevertheless be possible since the observed increase in stroke volume could be an indication of an increase in the ventricular contractility function. The different fractions of the calcium in the plasma (total and ionized & complexed calcium) increased during the exogenous calcium infusions but the proportion of the fractions remained always constant.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of digoxin followed by dopamine on the cardiovascular depression during a standard halothane anaesthesia in dorsally recumbent, ventilated ponies.

The influence of digoxin (0.01 mg/kg) given as an intravenous bolus followed by dopamine at different infusion rates (1.25, 2.5 and 5.0 micrograms/kg/min) on the cardiovascular depression during a standard halothane anaesthesia was studied in dorsally recumbent ventilated ponies. Preanaesthetic digitalization induced no clear positive cardiovascular effects over 30 minutes, except for non-significant increases in mean pulmonary artery pressure and total pulmonary resistance. These changes were probably time-related. No specific side-effects related to the fast intravenous digitalization were noticed. Dopamine at lower infusion rates (1.25 and 2.5 micrograms/kg/min) given minimally 30 minutes after the digitalization did not induce further changes (only minor non-significant increases in cardiac output and systemic blood pressure). Dopamine infusions at a higher infusion rate (5.0 micrograms/kg/min) improved the cardiovascular depression (significant increases in cardiac output and systemic blood pressure while total peripheral resistance tended to decrease). Heart rate, blood gases and total pulmonary resistance remained constant. The combination of a fast acting inotropic agent, dopamine, and a slow acting inotropic drug, digoxin, induced positive effects in reversing the cardiovascular depression and might therefore be useful during clinical anaesthesia in the horse.