Ankylosis of tarsometatarsal luxations using external fixation.

This report evaluates the suitability of using an external fixator as the sole means of correcting tarsometatarsal luxations. Four dogs were included in this report. Each dog weighed more than 20 kg and had sustained a tarsometatarsal luxation with plantar, medial or lateral instability. The luxations were immobilised with an external fixator for between 12 and 17 weeks. The surgery did not involve soft tissue dissection, debridement of articular cartilage or a cancellous bone graft and no external coaptation was used postoperatively. The result of this treatment was to ankylose the tarsometatarsal luxation and allow the dogs to return to normal function.

Survey for papillomatous digital dermatitis in Australian dairy cattle.

OBJECTIVE: To determine whether Treponema-associated papillomatous digital dermatitis (PDD) occurs in Australian dairy cattle. DESIGN: Mail-out questionnaire and histological and bacteriological examination of biopsy tissue from suspect PDD lesions. PROCEDURE: The questionnaire was mailed to 375 veterinarians to evaluate their knowledge of PDD, determine if they had observed the disease in Australian dairy cattle, and to request biopsy material from suspicious cases. Biopsies were examined for histological and bacteriological evidence of PDD, including for the presence of spirochaetes. RESULTS: Eighty-eight replies to the questionnaire were received (23.5%). Of 52 respondents who were aware of PDD as a possible cause of lameness, 26 reported observing the condition in Australian cattle. Of 32 respondents who were unaware of the condition, 6 reported observing lesions that might have been PDD. The majority of reports of PDD-like lesions came from the southern Australian states, the condition occurring during periods of high rainfall and proving responsive to topical or parenteral application of antimicrobials. Biopsies from five erosive lesions showed histological similarity to PDD whereas biopsies from five proliferative lesions were consistent with chronic inflammation, fibroma or cutaneous papilloma. The presence of spirochaetes was not demonstrated in any of the lesions by histological or bacteriological methods. CONCLUSION: Anecdotal reports and analysis of biopsy material confirm that a condition similar to PDD does occur sporadically in dairy cattle in southern Australia. However, this condition has so far not been shown to be associated with the presence of spirochaetes in the lesions.

The role of handouts, note-taking and overhead transparencies in veterinary science lectures.

OBJECTIVE: To study student and staff views of the role and use of handouts, note-taking and overhead transparencies in veterinary science lectures at the University of Queensland METHODS: The Nominal Group Technique was used to help develop a questionnaire, which was completed by 351 students (a response rate of 84%) and 35 staff (76%) from the 5 years of the veterinary course. The data were analysed using the SAS statistical computer package. RESULTS: Staff and students held different views as to the frequency with which handouts should be used, their educational value, and whether they should be complete or partial. Fewer students than staff agreed that handouts discourage further reading in a subject. Almost all staff and students saw the central functions of note-taking to be provision of notes for subsequent revision and encoding information given by the lecturer. More students than staff however, considered that note-taking in lectures interferes with understanding. Staff and students held similar views as to the uses of overheads in lectures. Interestingly however, more staff than students agreed that overheads often contain too much information. CONCLUSION: Both students and staff saw the central role of note-taking as providing a set of good notes for revision. Generally students preferred that this information be provided in the form of partial or complete handouts, while staff preferred students to take notes and to read outside lectures. Surprisingly, more staff than students felt that overhead transparencies often contained too much information. Note-taking, handouts and overhead transparencies need to be linked in a coherent educational strategy to promote effective learning.

Urethral instability: clinical and urodynamic characteristics.

Filling cystometry was performed on 397 patients with lower urinary tract complaints. The overall prevalence of urethral instability was 12.6% (50/397). Of these 187 patients had detrusor instability (DI). Within the DI group, clinical and urodynamic characteristics were compared. Patients with an unstable urethra had a shorter functional urethral length (P = 0.005). For those with DI, 28 of 187 (15%) had urethral instability. Forty (21%) women had a decrease in maximal urethral pressure that preceded the detrusor contraction (type II DI). When those with type II DI were excluded, the difference in functional urethral length was not observed. Patients with type II DI experienced an earlier sensation of fullness of 228 mL compared with 283 mL for the other patients with DI (P = 0.001). There was a positive association between urethral instability and type II DI. Four different patterns of urethral pressure changes were observed. Based on these findings, it appears that a urethral abnormality may be the primary disorder in patients with type II DI. The differentiation of the various subtypes of urethral instability and DI might be important for directing therapy.

Treatment of intrinsic sphincter deficiency using autologous ear chondrocytes as a bulking agent.

Intrinsic sphincter deficiency (ISD) is frequently treated with collagen bulking at the bladder neck. The standard material used, Contigen, biodegrades over 3-19 months requiring repeated injections to maintain efficacy. The study objective was to evaluate use of autologous ear chondrocytes for treatment of ISD. Women with documented ISD had harvest of auricular cartilage. Chondrocytes were isolated from the cartilage and expanded in culture and formulated with calcium alginate to form an injectable gel. Thirty-two patients received a single outpatient injection just distal to the bladder neck. Outcome measures included voiding diary, quality-of-life scores, incontinence severity grading, and pad weight testing. Incontinence grading indicated 16 patients dry, and 10 improved at 12 months for a total of 26 of 32 (81.3%) dry and improved after one treatment. Only four patients had a 12-month pad weight test over 2.2 g. Quality-of-life scores improved significantly after treatment. There was a decrease in incontinence impact scores in all categories. The urogenital distress inventory declined for all categories except bladder emptying and lower abdominal pain. Endoscopic treatment of ISD with autologous chondrocytes is safe, effective, and durable with 50 % of patients dry 12 months after one injection. Twenty-six of 32 patients dry or improved at 3 months after the injection maintained the effect at the 12-month visit.

The role of lectures in veterinary education.

OBJECTIVE: To study the role of lectures from the perspective of staff and students involved in the veterinary course at The University of Queensland. METHODS: The Nominal Group Technique of Delbecq et al, which provides the maximum opportunity for group members to put forward points, was used to help develop a questionnaire which was completed by 351 students (a response rate of 84%) and 35 staff (76%) from the five years of the veterinary course, and was analysed using the SAS System for Windows. RESULTS: Almost all the staff and students agreed that lectures should fulfil many roles including stimulating and motivating students and encouraging them to think, as well as presenting ideas and concepts and an indication of the structure and relevance of the material. They should provide a guide for effective deep learning, but not encourage rote (or superficial) learning. A smaller percentage of staff and even fewer students agreed that lectures did fulfil these roles, especially those directed at encouraging students to look beyond simple memorisation of facts. The perceived disparity between reality and the ideal was greater amongst the older, clinical students than amongst their more junior colleagues. CONCLUSIONS: The focus of attention in lectures needs to change from the superficial, rote learning of information to deep, active learning directed at using information to solve problems that are perceived by the students to be relevant. If done in a stimulating and interesting way, this should develop skills in reasoning and critical analysis as well as providing a framework for storage and recall. It should also increase the motivation towards learning both during the veterinary course, and over the professional lifetime. Furthermore, the place of the lecture in veterinary education needs to be reassessed regularly in the face of newly-emerging educational technology.

Leak-point pressure: clinical application of values at two different volumes.

A prospective analysis of 306 consecutive patients with genuine stress incontinence was performed to evaluate the clinical usefulness of additional leak-point pressure (LPP) determination at 200 ml. LPP values at both volumes were compared to maximal urethral closure pressure (MUCP) in an attempt to determine a critical cut-off value for the detection of a low MUCP (< or =20 cmH2O). A positive LPP at 150 ml was found in 157 patients. The mean LPP for patients with a low MUCP was 58.5 cmH2O compared to 71.6 for those with a normal MUCP, which was statistically significant (p = 0.01). The correlation coefficient between LPP and MUCP was 0.317. A negative LPP was found in 30% (24/79) of the total having a low MUCP. The addition of values for LPP at 200 ml resulted in an increase in the number who leaked to 191, a 50% increase in the detection rate of low MUCP and a statistically significant relationship between LPP < or =60 cmH2O and low MUCP. Various critical cut-off values for LPP demonstrated good specificity but poor sensitivity for the detection of a low MUCP. It was concluded that there was a statistically significant relationship between LPP and MUCP. Performing LPP at 200 ml provides additional clinically useful diagnostic information.

Randomized trial of antibiotic prophylaxis for combined urodynamics and cystourethroscopy.

OBJECTIVE: To determine the efficacy of prophylactic nitrofurantoin in preventing bacteriuria after urodynamics and cystourethroscopy. METHODS: We assumed that nitrofurantoin prophylaxis would decrease the rate of infection after urodynamics and cystourethroscopy from 19% to 5%. All women presenting for urodynamics and cystourethroscopy during a 27-month period were offered enrollment, and 142 were randomly assigned to receive two doses of long-acting nitrofurantoin 100 mg (n = 74), or two doses of placebo (n = 68). Nitrofurantoin and placebo capsules were identical, and subjects and physicians were masked to group assignment. Differences were assessed using Student t test for continuous data and chi2 analysis for dichotomous data. RESULTS: There were no statistical differences in demographic characteristics or final diagnoses between groups. Seven women (5%) who had bacteriuria on initial urine culture were not included in the final analysis. The frequency of bacteriuria in the postinstrumentation urine cultures was 6% overall, 7% in the treatment group, and 5% in the controls, a nonsignificant difference ([relative risk] 1.49, [confidence interval] 0.37, 5.95). The power of the study was 33% to detect a significant difference. CONCLUSION: Bacteriuria after combined urodynamics and cystourethroscopy was not improved by a 1-day course of nitrofurantoin.

Clinical and urodynamic predictors of delayed voiding after fascia lata suburethral sling.

OBJECTIVE: To determine the time to resumption of normal voiding after a fascia lata sling and whether any clinical, operative, or urodynamic variables predict it. METHODS: Between January 1993 and September 1996, 62 women underwent fascia lata suburethral sling operations for intrinsic sphincter deficiency or recurrent stress incontinence. The demographic, operative, and urodynamic data of 61 of these patients were analyzed. RESULTS: The mean number of days to resumption of normal voiding was ten. Three patients (5%) developed permanent retention. Patients 65 years and older were more likely than younger patients to have prolonged catheterization (16 versus 7 days, P=.008). Women who had additional procedures voided at a mean of 15 days compared to nine days for those having slings only (P=.029). A preoperative urine flow rate less than 20 mL/sec was associated with late voiding. There was no significant relationship between preoperative voiding mechanism and voiding time. CONCLUSION: Resumption of normal voiding occurred earlier than reported by others. Age over 65 years, additional surgical procedures, and low peak flow rates were risk factors for delayed voiding. Time to normal voiding was independent of the preoperative voiding mechanism.

Suburethral abscess: a complication of periurethral collagen injection therapy.

BACKGROUND: Urinary tract infection after collagen injection is well documented. Other adverse reactions are rare. CASES: Three women experienced suburethral abscess after repeat periurethral injections. All patients received local skin preparation and postprocedural antibiotics. Symptoms failed to resolve with antibiotics. The first two patients presented after 5 weeks and 10 days with irritative voiding symptoms and a tender suburethral swelling. The first patient was treated with excision. Spontaneous rupture into the urethra occurred with the second. The third woman presented with acute urinary retention at 102 days. A large suburethral mass was drained successfully in the office. CONCLUSION: Suburethral abscess may be a delayed complication of periurethral collagen injections, not preventable by postprocedural antibiotics. Drainage is required.

Fascia lata suburethral sling vs. Burch retropubic urethropexy. A comparison of morbidity.

OBJECTIVE: To compare morbidity from the fascia lata sling to that from the Burch procedure. STUDY DESIGN: The charts of 64 consecutive patients undergoing the two procedures were reviewed for perioperative, immediate postoperative and delayed postoperative complications. RESULTS: Mean age was significantly older and prior surgery more common in the sling group, but parity and weight were comparable for the two groups. Operative time, estimated blood loss, change in hematocrit, incidence of transfusion, use of narcotics and hospital stay were not statistically different. Duration of catheter use was 2.2 days longer in the sling group (8.96 vs. 6.75 days, P = .387). Comparison of the sling vs. Burch, respectively, showed persistent urge incontinence in 42.8% and 40.0%, new urge incontinence in 22.2% and 16.6%, and cystotomy in 11% and 0%. CONCLUSION: The fascia lata sling procedure has morbidity comparable to that of Burch retropubic urethropexy. Urge incontinence needs to be specifically addressed preoperatively in both groups of patients.