Tunnel grafting for wound repair in horses: a novel technique in graft production and placement.

There are several skin grafting methods described in the human and animal literature. Currently, there are five types of free grafts used in horses: pinch and punch grafts, split and full-thickness sheet or mesh grafts and tunnel grafts. Published methods of tunnel grafting describe the use of alligator forceps. The alligator forceps create a poor tunnel and are excessively traumatic to the granulation bed. This technique utilised a 13G Jamshidi needle that was placed across the granulation bed and created a uniform tunnel. The Jamshidi needle was atraumatic to the granulation bed increasing the opportunity for graft survival. A twin bladed scalpel allowed for the quick creation of uniform width grafts. Removal of the overlying tunnel 'roof' took place 5-14 days later to allow graft expansion. This case series included five horses with distal limb wounds and one with a wither injury. Four horses required general anaesthesia for graft placement and three required general anaesthesia for the removal of the tunnel roof. The acceptance of the grafts varied from 70% to 100%. Graft expansion to cover the granulation tissue took 2-5 months. This case series demonstrates that this technique of graft production and placement is an easy method for achieving successful skin grafting. Compared to other graft types, tunnel grafts are more readily accepted. Cosmetic and functional results achieved are better than those with pinch and punch grafts. Tunnel grafting does not require expensive equipment or advanced training, and in some cases can be performed under standing sedation.

Seawater neutralization of alkaline bauxite residue and implications for revegetation.

Reaction of bauxite residue with seawater results in neutralization of alkalinity through precipitation of Mg-, Ca-, and Al-hydroxide and carbonate minerals. In batch studies, the initial pH neutralization reaction was rapid (<5 min), with further reaction continuing to reduce pH for several weeks. Reaction with seawater produced a residue pH of 8 to 8.5. Laboratory leaching column studies were undertaken to provide information on seawater neutralization of the coarse-textured fraction of the waste, residue sand (RS), under conditions comparable with those that might be applied in the field. An 0.80-m-deep column of RS was neutralized by the application of the equivalent of 2-m depth of seawater. In addition to lowering the pH and Na content of the residue, seawater neutralization resulted in the addition of substantial amounts of the plant nutrients Ca, Mg, and K to the profile. Similar results were also obtained from a field-scale assessment of neutralization. However, the accumulation of precipitate, consisting of hydrotalcite, aragonite, and pyroaurite, in the drainage system may preclude the use of in situ seawater neutralization as a routine rehabilitation practice. Following seawater neutralization, RS remains too saline to support plant growth and would require fresh water leaching before revegetation.

Effects of chronic low back pain, age and gender on vertical spinal creep.

This study investigated the effect of chronic low back pain, age, gender, and time of measurement on the magnitude of vertical spinal creep (VSC) and its recovery. A mixed design, involving three independent variables (chronic low back pain, age, and gender) and one repeated variable (time), was used. One hundred and six subjects of both genders, with and without chronic low back pain, aged between 20 and 60 years, participated in the study. The measurement of VSC and its recovery was performed using a seated stadiometer that allowed continuous measurement of VSC without changing the subject's posture over 25 min. Unloaded VSC was measured during the initial 5 min, followed by 10 min with an additional load of 15% of the subject's body weight and then for a further 10 min after the removal of the load. Subjects were grouped into one of eight categories according to the presence of chronic low back pain, age (20-39 years or 40-60 years) and gender. Repeated measures analysis of variance was computed. A significant increase in VSC with time of measurement was observed (p<0.001). No significant main effects for chronic low back pain, age, or gender were found at any time during the 25-min VSC testing protocol. Significant interactions were found between age and gender during the loaded (p=0.02) and unloaded (p=0.02) phases. A significant interaction was found between chronic low back pain and gender at the end of the unloaded phase (p=0.04). These findings suggest a combined influence of chronic low back pain, age, and gender on VSC and its recovery and that the dominance of each variable changed with the time of the measurement. Thus, subjects who differ in the presence of chronic low back pain, age, and gender should not be combined for statistical analysis of VSC and its recovery.

Cervical implant from villoglandular endometrial adenocarcinoma masquerading as cervical villoglandular adenocarcinoma.

This is an unusual presentation of a rare subtype of endometrial adenocarcinoma (villoglandular papillary carcinoma, VGPC) in a 71-year-old woman, which was initially diagnosed on cervical biopsy as being primary cervical VGPC. Loop excision failed to show any evidence of residual disease. Subsequent hysterectomy revealed a localized villoglandular carcinoma involving the uterine fundus and invading the inner one-third of the myometrium, the background endometrium was atrophic. The remaining cervix contained a focus of papillary forming endometrial type adenocarcinoma involving the surface epithelium and the superficial subepithelial glands. In conclusion, VGPC of cervix occurs mainly in young women and can be treated conservatively, pathologists should be cautious in making such a diagnosis in a postmenopausal woman before ruling out a primary endometrial origin.

Reliability of the vertical spinal creep response measured in sitting (asymptomatic and low-back pain subjects).

Vertical spinal creep (or change in stature) has been used as an index of spinal loading, yet reliability of the testing protocol has not been fully examined. This study investigated the reliability of a vertical spinal creep response in 10 asymptomatic and five low-back pain subjects. Each subject performed the 25-min testing protocol, which consisted of three phases (5-min preload, 10-min loaded and 10-min unloaded), at the same time on two separate days. Good reliabilities in vertical spinal creep response between two days of testing were demonstrated for both asymptomatic and low-back pain subjects.

Contribution of soft tissue deformation below the sacrum to the measurement of total height loss in sitting.

This study investigated the contribution of soft tissue deformation below the sacrum (S) and vertical spinal creep to total height loss (THL) measured in sitting. Eight asymptomatic subjects (four males, four females) aged between 21 and 51 years were measured. Simultaneous measurement of THL and S were commenced after the subjects had been sitting for 5 min. THL was recorded while subjects were positioned in a seated stadiometer, which controlled their spinal posture. S was measured by placing an ultrasound transducer at the level of the top of the subject's sacrum. Over 25 min of sitting with loaded and unloaded interventions applied to their spine, different response characteristics between S and THL were noted. This study demonstrated that soft tissues below the sacrum could contribute up to 30% on average of total height loss. This suggests that researchers should take into account the soft tissue deformation outside the spine when studying vertical creep in sitting.

Adolescent versus adult responses to vertical spinal loading.

This study compared the vertical spinal creep response between adolescent and adult males. Thirty healthy male subjects, 15 adolescents (aged 12 to 16 years) and 15 adults (aged 30 to 57 years) were measured. Spinal creep was measured continuously over 25 min under loaded and unloaded conditions using a seated stadiometer that controlled spinal posture. Both adolescent and adult subjects showed significant increase in vertical spinal creep with time but the magnitude of vertical spinal creep was significantly greater in adolescent than in the adult subjects.

Three-dimensional analysis of active cervical motion: the effect of age and gender.

OBJECTIVE: To describe the effects of age and gender on three-dimensional (3D) active cervical spine motion. DESIGN: This was a descriptive study. BACKGROUND: This study expanded on previous investigations of age and gender effects on single plane motion of the cervical spine. METHODS: Sixty female and 60 male asymptomatic, normal volunteers, aged between 20 and 59 years, were examined in a standardized seated position. The 3 SPACE Isotrak system was used to measure simultaneous 3D motion of the cervical spine. RESULTS: The mean range of all the primary movements decreased significantly with age. For flexion/extension the greatest decrease occurred between the 20- and 30-year-olds, whereas for both lateral flexion and rotation, significant differences were demonstrated in subjects aged two decades apart. The coupling of motion associated with rotation was significantly related to age. CONCLUSION: Age had a significant effect on all of the primary movements. Age had less effect on the range of the coupled movements, in that the only movements to be affected were lateral flexion and extension occurring during cervical rotation. Gender had no marked effect on the primary or the coupled movements. RELEVANCE: This study provides normative data for the effects of age and gender on three-dimensional analysis of active cervical spine motion, which can be used for comparison with specific patient populations. The high level of intra-subject test-retest reliability renders the3 SPACE system of value for clinical measurement of movement pre- and post-treatment intervention for cervical spine disorders.

Effects of various isoresistive training programmes on trunk muscle performance.

Isoresistive movements provide a functional method of testing muscle performance and of providing exercise; the resistance applied is usually a percentage of the maximal isometric torque which can be developed by individual subjects. The aim of the current study was to compare the effectiveness of dynamic isoresistive exercise programmes using 25, 50 or 75% of the maximum isometric flexion torque and static isometric exercises for improving the performance of the trunk flexors and extensors. Subjects comprised 42 asymptomatic females aged 18-25 years who were randomly assigned to control or exercise groups. The exercise groups undertook 2 min of exercise 3 times per week. The control subjects showed significant improvement between tests indicating a strong learning effect. The study showed that the subjects who exercised at 50% of maximum flexion isometric torque achieved the greatest increases in muscle performance on most measures. maximal isometric flexion and extension torques did not significantly change in any of the groups. Flexion and extension velocity and power were the muscle performance characteristics which improved the most in response to the training programmes. RELEVANCE:--This paper attempts to determine which among several options is the most effective isoresistive protocol for conditioning trunk muscle performance, as improved strength and power of these muscles may contribute in preventing episodes of LBP.

Superior check ligament desmotomy for treatment of superficial digital flexor tendonitis in thoroughbred and standardbred horses.

Bilateral superior check ligament desmotomy was performed on 31 Thoroughbred and 17 Standardbred horses as the sole method of treatment for superficial digital flexor tendonitis. Horses resumed racing between 6 and 19 months after surgery. Horses that were able to compete in 5 or more races without injury to the tendon again were considered to have had a successful return to racing. Twenty-five Thoroughbreds were suitable for later study and 13 of these (52%) raced on 5 or more occasions. Fifteen Standardbreds were suitable for later study and 10 of these (66%) raced on 5 or more occasions. Within the racing industry it is generally thought that about 20 to 30% of horses with superficial digital flexor tendonitis can return to racing after a prolonged rest. The results of this study suggest that bilateral superior check ligament desmotomy may improve the prognosis for a horse returning to racing after injury to the superficial digital flexor tendon.

Histologic evaluation of nerve muscle pedicle graft used as a treatment for left laryngeal hemiplegia in standardbreds.

A nerve muscle pedicle (NMP) graft was placed in the cricoarytenoideus dorsalis (CAD) muscle of 6 horses with induced left laryngeal hemiplegia. The NMP graft was created by use of the first cervical nerve and omohyoideus muscle. In 1 horse (control), the first cervical nerve was transected after placement of the NMP graft. One year after the surgical procedure, horses were examined endoscopically and then anesthetized. While the larynx was observed endoscopically, the first cervical nerve was stimulated. Horses were subsequently euthanatized, and the larynx was harvested. Prior to anesthesia, the endoscopic appearance of the larynx of all horses was typical of laryngeal hemiplegia. During anesthesia, stimulation of the first cervical nerve produced vigorous abduction of the left arytenoid in principal horses but not in the control horse. The right cricoarytenoideus lateralis and CAD muscles were grossly and histologically normal. Also, the left cricoarytenoideus lateralis was atrophic in all horses as was the left CAD muscle of the control horse. In contrast, the left CAD muscle harvested from principal horses had evidence of reinnervation with type 1 or type 2 fiber grouping. One year after the NMP graft procedure, horses with left laryngeal hemiplegia had reinnervation of the left CAD muscle. In another study, reinnervation was sufficient to allow normal laryngeal function during exercise. Combined, these data suggest that the NMP graft procedure is a viable technique for the treatment of left laryngeal hemiplegia in horses.

Treatment of left laryngeal hemiplegia in standardbreds, using a nerve muscle pedicle graft.

The efficacy of a nerve muscle pedicle (NMP) graft in restoring upper airway function was evaluated in exercising horses with induced left laryngeal hemiplegia. The NMP graft was created from the first cervical nerve and the omohyoideus muscle and transplanted into the left cricoarytenoideus dorsalis muscle. Seven adult Standardbreds were trained to exercise on a treadmill inclined at 6.38 degrees. With the horses at rest and exercising at 4.2 and 7.0 m/s, the following variables were recorded: peak inspiratory and expiratory transupper airway pressures (defined as the pressure difference between a lateral tracheal catheter and a mask catheter), peak inspiratory and expiratory air flow, inspiratory and expiratory impedance, tidal volume, minute ventilation, heart rate, and respiratory frequency. Measurements were made before left recurrent laryngeal neurectomy (LRLN), 28 days after LRLN, and 12, 24, and 52 weeks after the NMP graft (n = 5) or sham operation (n = 2). Before LRLN, exercise increased inspiratory and expiratory air flow and transupper airway pressure, whereas the impedance was unchanged. After LRLN, transupper airway inspiratory pressure and impedance were significantly greater and inspiratory air flow was significantly less than baseline values at 7.0 m/s. The sham operation did not improve airway function. Twelve weeks after insertion of the NMP graft, inspiratory impedance and inspiratory air flow were significantly different (improved) from LRLN values. Twenty-four weeks after insertion of the NMP graft, inspiratory impedance was not significantly different from LRLN values.(ABSTRACT TRUNCATED AT 250 WORDS)

A monoclonal antibody capture assay for intestinal alkaline phosphatase and the measurement of this isoenzyme in pregnancy.

Intestinal ALP was purified from meconium to a specific activity of 1,100 U/mg protein and used as antigen in the preparation of 7 monoclonal antibodies. Two of these antibodies were specific for intestinal ALP and reacted with different epitopes. Both bound adult intestinal ALP better than fetal intestinal ALP. One of these antibodies was used to establish a capture assay for intestinal ALP in human serum over the range 0.5-16 U/l. Reference ranges of serum intestinal ALP concentrations were established in relation to blood groups. Measurement of intestinal ALP in the serum of pregnant women showed no correlation with pre-term fetal passage of meconium.

Is normal pregnancy cholestatic?

Fasting and 2-h postprandial concentrations of conjugated cholate and conjugated chenodeoxycholate in plasma were measured sequentially through normal pregnancy in a consecutive series of 26 women. Fasting concentrations of cholate significantly increased by 34 weeks and remained so up to 6 weeks post partum. No significant changes were found in fasting or 2-h postprandial concentrations of chenodeoxycholate. Postprandial concentrations of cholate were significantly higher post partum than at 22 weeks of pregnancy. The ratio of fasting cholate: chenodeoxycholate rose from 1.1 : 1.0 at 20 weeks to 1.9 : 1.0 at 38 weeks. In the third trimester, concentrations of conjugated cholate were elevated above the laboratory reference range in 5 of these 26 normal pregnancies. It is concluded that normal pregnancy is associated with mild sub-clinical cholestasis.