Treatment of class 2 malocclusion by corrective osteotomy using two short locking compression plates.

OBJECTIVE: To describe a symphyseal osteotomy stabilised with two short locking compression plates (LCPs) for treatment of class 2 malocclusions. STUDY DESIGN: Case series. METHODS: Five horses (age range 8 months to 5¾ years) with overjets and/or overbites ranging from 6 to 32 mm and from 0 to 60 mm, respectively, were treated by osteotomy through the caudal third of the mandibular symphysis, cranial to the interdental space. After cranial distraction and ventral rotation of the rostral part of the mandible, two short (5/6 hole), bent 3.5 mm LCPs were applied ventro-laterally and secured with two or three locking screws on each side of the osteotomy. In one case, the osteotomy gap was filled with bone marrow. RESULTS: Final outcome was good to excellent. Two cases needed a second corrective surgery, one because of non-occlusion of the cheek teeth and another because of abaxial deviation of the rostral portion of the mandible. In three cases with a persistent fistula, LCPs were removed after bridging; drainage resolved and wounds healed. The time to bridging of the osteotomy gap ranged from 2 to 6.5 months. The procedure is technically challenging. It is important that the incisors are well aligned, which proved to be difficult when there was an abnormal maxillary incisor arcade. Incisors should not make contact when LCPs are fixed. The cheek teeth, however, should have good occlusion after positioning and fixation of the LCPs. Endodontic treatment of open incisor pulp cavities may be helpful. MAIN LIMITATIONS: The study population was small and relatively heterogeneous in severity. A larger population with more severe cases might have allowed for a more definitive assessment of the value of the technique for clinical practice. CONCLUSIONS: This technique can be used to achieve a good correction for class 2 malocclusions. The approach provides adequate stability with smaller implants than other published techniques that require transection of both rami. The technique is less invasive and preserves the roots of the incisors and cheek teeth, as well as the mandibular canal.

Foramen epiploicum mesh closure (FEMC) through a ventral midline laparotomy.

BACKGROUND: Preventive laparoscopic closure of the epiploic foramen (EF) has previously been described, but methods for EF closure during laparotomy for treatment of colic are lacking. OBJECTIVES: To describe the foramen epiploicum mesh closure (FEMC) technique through a ventral midline laparotomy in horses under general anaesthesia and its outcome. STUDY DESIGN: Terminal surgical experiment and in vivo study. METHODS: In a pilot study, a standard ventral midline laparotomy was performed under general anaesthesia in 10 experimental horses and a three-dimensional expandable diabolo-shaped mesh construct was manually introduced through the EF into the omental vestibule. The laparotomy incision was routinely closed after which the horses were subjected to euthanasia. Subsequently, the cadavers were extensively manipulated and finally mesh position was verified during necropsy. Thereafter, a ventral midline laparotomy, with simulation of abdominal manipulations during colic surgery was performed on six experimental horses. A three-dimensional expandable diabolo-shaped mesh with a radiological marker was introduced as in the pilot study. Clinical and laboratory parameters were recorded during the post-operative period. Four weeks after the intervention, abdominal radiography and laparoscopy were performed in all six horses. RESULTS: Insertion of all 16 diabolo-shaped mesh constructs during laparotomy was uneventful. The 10 mesh constructs of the pilot study were positioned correctly at necropsy. No post-operative clinical or laboratory parameter alterations were noticed in the other six horses, apart from a transient leucocytosis and an increase in serum amyloid A. Abdominal radiography at 4 weeks revealed consistent positioning of the mesh marker. Laparoscopy confirmed that all six EFs were closed, without intestinal adhesions. MAIN LIMITATIONS: Mesh insertion in clinical cases and during clean contaminated surgery was not investigated. CONCLUSION: The FEMC technique via laparotomy provides a fast, simple and reliable procedure to obliterate the EF and may be useful during EFE surgery to prevent recurrence of the disease, avoiding a subsequent laparoscopic procedure.

Development of a new laparoscopic Foramen Epiploicum Mesh Closure (FEMC) technique in 6 horses.

REASONS FOR PERFORMING STUDY: Epiploic foramen entrapment (EFE) is, based on the number of reports in the literature, a relatively important life-threatening cause of colic in horses that could be prevented by closing the epiploic foramen (EF) in horses at risk of developing EFE. OBJECTIVES: To describe the laparoscopic foramen epiploicum mesh closure (FEMC) technique and its outcome. STUDY DESIGN: Descriptive experimental study. METHODS: The EF of 6 horses was closed with the FEMC technique. A diabolo-shaped constructed mesh was introduced into the omental vestibule through the EF under laparoscopic visualisation in the standing sedated horse. Clinical and laboratory parameters were recorded during the post operative period. Four weeks after the intervention, repeat laparoscopy was performed in all horses. Three horses were subjected to euthanasia one, 2 and 3 months after the intervention, and were examined on necropsy and histopathology. The remaining 3 horses were followed clinically for 6 months. RESULTS: The 6 FEMC procedures were performed successfully in a median surgery time of 22 min (range 18-27 min). One horse was treated for large colon impaction in the immediate post operative period. On repeat laparoscopy at 4 weeks all 6 EFs were closed and no undesired adhesions were identified. This was confirmed on gross and histopathological examination of the 3 horses that were subjected to euthanasia. The 3 remaining horses were clinically normal in the 6-month post operative observation period. CONCLUSIONS: This FEMC technique provides a fast, simple, reliable and safe procedure to obliterate the EF and may be useful in horses at risk for EFE.

A topographic anatomical study of the equine epiploic foramen and comparison with laparoscopic visualisation.

REASONS FOR PERFORMING STUDY: There are no previous studies correlating the anatomy of the equine epiploic foramen and its defining structures with laparoscopic images. OBJECTIVES: The purpose of this study was to describe the precise anatomy of the epiploic foramen and omental vestibule, to quantify the dimensions of the epiploic foramen and to relate these findings to laparoscopic images. STUDY DESIGN: Descriptive study of cadaver material and laparoscopic images. METHODS: Thirty-two horses subjected to euthanasia for reasons unrelated to colic were studied. Two cadavers were used to make vascular casts of the coeliac artery and portal vein. In 30 cadavers the epiploic foramen and omental vestibule were cast with a polyurethane prepolymer immediately after euthanasia. The cast served as a landmark during dissection and the circumference of the epiploic foramen was measured from these casts. Histology was performed on structures defining the epiploic foramen in 2 horses. Laparoscopic images from 6 standing right flank procedures were reviewed. RESULTS: The defining structures of the epiploic foramen and omental vestibule are the hepatoduodenal ligament, hepatogastric ligament and the gastropancreatic and hepatopancreatic folds. The hepatoduodenal ligament has a secondary fold which forms the ventral border of the epiploic foramen, consisting of a central connective tissue core of mainly elastin fibres. The hepatic artery for part of its course is incorporated in the hepatoduodenal ligament. All these structures are clearly visible laparoscopically. The mean circumference of the epiploic foramen is 11.6 ± 2.6 cm and its circumference is positively correlated with body weight but is unrelated to age or gender. CONCLUSIONS: Several clinically relevant structures delineate the epiploic foramen. Its defining structure consists, in part, of elastin fibres. Anatomical and laparoscopic knowledge may assist surgeons in developing interventions to treat diseases involving the epiploic foramen.

Bleeding in the subarachnoid space: a possible complication during laser therapy for equine progressive ethmoid haematoma.

A 10-year-old KWPN (Royal Warmblood Studbook of the Netherlands) gelding was euthanized after developing severe neurological symptoms preceded by severe epistaxis during laser treatment for progressive ethmoid haematoma (PEH) in the right nasal cavity. Postmortem examination of the head revealed a large amount of clotted blood between the right ventral and dorsal conchae in the nasal cavity and acute haemorrhage in the right subarachnoid space. Histologically, there was moderate, acute polioencephalomalacia in the neuropil adjacent to the haemorrhage. The haemorrhages were most likely caused by the laser treatment and therefore should be considered a possible complication that could lead to severe peracute neurological symptoms.

[Prevalence of dental disorders in 483 horses and ponies]. / De prevalentie van gebitsafwijkingen bij 483 paarden en pony's.

Prevalence of dental disorders in 483 horses and ponies Five equine veterinarians working at three equine referral hospitals examined the oral cavity of 483 horses and ponies prior to surgery, to gain information about the prevalence of common dental disorders in the horse. A thorough examination, using hands/fingers, a full-mouth speculum, a dental mirror and a good light source, is essential to detect such disorders. Many horses examined needed dental attention even though there were no problems with mastication or riding. The most detected abnormalities were sharp enamel points on the buccal side of the upper arcade and the lingual side of the lower arcade, and hooks at 106/206 and 311/411. Regular dental care would improve the condition and welfare of horses.

Diagnostic findings in a lame-free dog with complete rupture of the biceps brachii tendon. A case report in a unilaterally affected working Labrador Retriever.

A case of a complete rupture of the biceps brachii tendon in a lame-free three-year-old Labrador Retriever is described. The dog had a history of chronic lameness following a trauma, but had become lame-free shortly before presentation. Clinical examination, biceps tendon test and shoulder instability tests under general anaesthesia were inconspicuous for shoulder instability. Routine radiographs, arthrography and ultrasound were suspicious for bicipital tendopathy. The definite diagnosis of a complete rupture of the biceps brachii tendon was made upon arthroscopic inspection of the glenohumeral joint.

Swimmer syndrome in a Devon rex kitten and an English bulldog puppy.

A three-week-old Devon rex kitten and a four-week-old English bulldog puppy were presented with "swimmer syndrome". The owners consulted several veterinarians who suggested euthanasia as the only possible solution for this condition. Physiotherapy in the puppy, and physiotherapy and bandaging in the kitten led to the resolution of the clinical signs and resulted in normal ambulation after several weeks. The authors concluded that intensive physiotherapy and dedication of the owner can lead to success.

A study of seven different types of grafts for jugular vein transplantation in the horse.

The aim of this study was to investigate the biological behaviour of vascular grafts replacing a section of the jugular vein in order to improve the results of the surgical treatment of complete thrombosis of the jugular vein in the horse. Seven graft types: fresh allograft, home frozen allograft, glutaraldehyde-fixed allograft, cryo-preserved allograft, PTFE-graft (Gore), small intestinal submucosa preparation (Cook) and fresh autograft, were randomly implanted in ponies. The grafts were removed after one month and examined histologically for: preservation of the graft structures, acceptance by the host, intima proliferation, presence of endothelium and patency. The glutaraldehyde- and cryopreserved grafts show reasonable results and the PTFE and autograft had the best results especially with respect to host acceptance, endothelium presence and patency. Further research is necessary to improve graft behaviour, especially to the aspect of endothelisation. Obstruction of the jugular vein in horses can be treated surgically.

[Colic surgery in the horse: a retrospective study of 272 patients]. / Koliekchirurgie bij het paard: een retrospectief onderzoek van 272 patiënten.

In the period from January 1995 until December 2000, 272 horses underwent a laparotomy for gastrointestinal disorders. The results of these surgeries were evaluated. From these 272 patients 176 (= 65%) were discharged in good health from the hospital. When the patients that were euthanized immediately after the start of the surgery, because of a fatal deterioration, were not taken into account, the short time survival rate was 77%. Strangulated small and large intestinal obstructions (48%) had a lower short time survival rate than non-strangulated obstructions (87%). Fatal postoperative complications occurred in 18% of the patients in which the surgery was completed. Postoperative shock was the most common cause. Non-fatal complications were found in 16% of the patients which survived surgery. The major non-fatal complications were incisional hernia and thrombophlebitis of the jugular vein. From the patients that survived the surgery 81% returned to their former level of performance. Early referral may decrease the percentage of fatal complications and improve the prognoses of surgery.

[Characteristics of communication of schizophrenic, neurotic, and healthy adolescents]. / Gesprächsmanagement bei gesunden, neurotischen und schizophrenen Jugendlichen.

Research on communication skills in psychotic patients demonstrates that in dialogues schizophrenics neglect the needs of the listener. There are only few linguistic studies which investigate the speech of schizophrenic children and adolescents. The verbal and non-verbal communication of schizophrenic, neurotic, and healthy adolescents during a problem solving situation was transcribed and compared by a content analysis. The transcripts were screened for dialogue control and communication disturbance of verbal/non-verbal activities of the speaker and listener: Dialogue control was defined by the variables signals of the speaker or signals of hearer and eye or body contact of the test person to the experimenter. Communication disturbance was defined as the amount of incomprehensible articulation and selections. Neurotic test persons produce the highest signals of speaker rate. In dialogues with neurotic and schizophrenic test persons the experimenter uses more signals of hearer than in dialogues with healthy test persons. In dialogues with neurotic test persons the experimenter shows more signals of the speaker than in dialogues with healthy test persons. Schizophrenics neglect more often the statements of the experimenter than in other dialogues and vice versa. Although the experimenter was instructed to restricted verbal behavior the communication intensified in the neurotic group. The communication in the schizophrenic group was characterized by frequent communication disturbance.

[Comparative outcome assessment of the wrist joint--mediocarpal partial arthrodesis and total arthrodesis]. / Vergleichende Ergebnisbewertung am Handgelenk--mediokarpale Teilarthrodese und Totalarthrodese.

Total wrist fusion still represents the main treatment for severe posttraumatic disorders of the wrist due to longstanding scaphoid nonunion (SNAC-wrist) or scapholunate dissociation (SLAC-wrist). During the last decade, midcarpal fusion has become more and more popular as it preserves motion. The question, however, remained if the preserved motion is of real benefit from a patient point of view, as complete pain relief is rare following this type of limited wrist fusion. The purpose of this study was to compare the outcome of both treatments with the modified Cooney wrist score and the DASH questionnaire. Between 1993 and 1997, 138 patients with progressive carpal collapse were treated either by midcarpal fusion (97) or total wrist fusion (41). Overall satisfaction was high in both groups with 86% (midcarpal fusion) and 84% (total wrist fusion). The traditional wrist score (70 versus 52 points) and the DASH questionnaire (33 versus 45 points) revealed the superiority of midcarpal fusion. The correlation between the wrist score and the DASH was statistically high (p < 0.001), demonstrating the specificity and validity of the DASH questionnaire. Midcarpal fusion is preferable to total wrist fusion for treatment of progressive carpal collapse (SLAC- and SNAC-wrist). The DASH represents a sensitive tool to evaluate the outcome of salvage procedures for treatment of disorders of the wrist.

[Fractures of the distal radius. Changing therapeutic strategies]. / Frakturen am distalen Radius. Wandel der therapeutischen Strategien.

Fractures of the distal radius represent one of the most common fractures and do have high social-economic relevance. For treatment they need practicable classification and therapeutic standards. The demand for stable osteosynthesis of A3-, B2-B3 and C1-C2-fractures is connected to dorsal or volar internal fixation with plate and practical autogenous cancellous bone grafting, even for the elder patient. The isolated external fixation with K-wires represent special situation. Supply of implants and biodegradable materials will support this development.

[The operative therapy of distal unstable radius fractures with dorsal and palmar plates. A retrospective study with respect to the DASH-score system]. / Operative Versorgung der distalen, instabilen Radiusfraktur mit der dorsalen/palmaren Abstützplatte. Eine retrospektive Studie unter Berücksichtigung des DASH-Score.

The distal radius fracture is the most common human skeletal injury. Predominantly woman in the 6th to 7th decade are found. There is a high correlation to the post menopause high turn over osteoporosis and its negative calcium balance. Due to the various multifactoral radius fracture combinations is a detailed classification with its correlated treatment important. The operative intervention in the past played a secondary roll. The newest concepts demand an exact reconstruction of the articulating surfaces through closed reposition and K-wire support, screw osteosynthesis, external fixation and its combinated forms. The posttraumatical joint changes with secondary palmar and dorsal dislocation of the radius base after reduction caused the exact therapy scheme with respect to the AO-classification to be developed. In the clinic and policlinic Oskar-Helene-Heim of the Free University in Berlin 213 patients were surgicly treated on distal radius fractures either from volar or dorsaly with a plate osteosynthesis between 1988-1998. In cases of multidirectionional fractures with compression of the articular surfaces we combined a bicortal bone block or spongiosa to support and to avoid the secondary dislocation and thus arthrosis. The study was divided in three sections, beginning with the clinical inspection. Further followed the X-ray evaluation and the assessment of the DASH-scores.

[Treatment outcome after surgical arthrodesis]. / Behandlungsergebnisse nach operativer Handgelenkversteifung.

Different results are reported following total wrist fusion. We performed 64 total wrist fusions due to posttraumatic or degenerative arthrosis of the wrist including Kienböck's disease. Clinical outcome was evaluated using the DASH-questionnaire. The mean DASH-function/symptom score was 45.6 points (0 points representing the best possible results and 100 points representing the worst possible result). In addition, 35 patients of this group were reexamined clinically and radiologically using a modified traditional wrist score. The preliminary results of the traditional wrist score and the DASH-score demonstrated a significant correlation (r = -0.71; p < 0.001) indicating the validity of the DASH-score. In conclusion, this study shows that wrist fusion results in significant pain reduction and improvement of function. However, complete pain relief cannot be expected for the majority of patients. The new AO wrist fusion plate is used in our standard technique of wrist fusion. In a further study, we will investigate the outcome of total wrist fusion in comparison with limited wrist fusion using the DASH-questionnaire and the wrist score.

Fractures of the distal radius. Changing therapeutic strategies.

Fractures of the distal radius represent one of the most common fractures and do have high social-economic relevance. For treatement they need practicable classification and therapeutic standards. The demand for stable osteosynthesis of A3-, B2-B3 and C1-C2-fractures is connected to dorsal or volar internal fixation with plate and practical autogenous cancellous bone grafting, even for the elder patient. The isolated external fixation with K-wires represent special situation. Supply of implants and biodegradable materials will support this development.

The operative therapy of distal unstable radius fractures with dorsal and volar plates. A retrospective study with respect to the DASH-score system.

The distal radius fracture is the most common human skeletal injury. Predominantly woman in the 6th to 7th decade are found. There is a high correlation to the post menopause high turn over osteoporosis and its negative calcium balance. Due to the various multifactoral radius fracture combinations is a detailed classification with its correlated treatment important. The operative intervention in the past played a secondary roll. The newest concepts demand an exact reconstruction of the articulating surfaces through closed reposition and K-wire support, screw osteosynthesis, external fixation and its combinated forms. The posttraumatical joint changes with secondary palmar and dorsal dislocation of the radius base after reduction caused the exact therapy scheme with respect to the AO-classification to be developed. In the clinic and policlinic Oskar-Helene-Heim of the Free University in Berlin 213 patients were surgicly treated on distal radius fractures either from volar or dorsaly with a plate osteosynthesis between 1988-1998. In cases of multidirectionional fractures with compression of the articular surfaces we combined a bicortal bone block or spongiosa to support and to avoid the secondary dislocation and thus arthrosis. The study was devided in three sections, beginning with the clinical inspection. Further followed the X-ray evaluation and the assessment of the DASH-scores.

[Experiences with spermatic cord ligation as a method of castration in the stallion. The surgical castration of the testicle in situ appears to be of value]. / Ervaringen met de bloedige zaadstrengligatie als castratiemethode bij de hengst. De chirurgische castratie waarbij de testikel in situ blijft.

In 22 stallions the surgically prepared spermatic cord was crushed and ligated. Preoperative and postoperative plasma-testosterone concentrations were measured and 60 days after surgery a HCG-stimulation test was carried out in 12 horses. In these 12 horses the testosterone production had ceased. In all 22 horses the wounds healed by primary intention. Ligation of the spermatic cord is a castration technique without surgical complications, at least in this study.

[Surgical treatment of an obliterating thrombosis of the jugular vein in a horse. Use of synthetic vessel prosthesis]. / Chirurgische behandeling van een oblitererende trombose van de vena jugularis van een paard. Gebruik van een synthetische vaatprothese.

A 6-year-old trotter gelding presented with exercise intolerance and swelling of the left side of the head during exercise and grazing. The complaints were caused by a complete thrombosis of the left jugular vein. In this case report a surgical approach is described in which a bypass was created with a synthetic vascular graft. After treatment the horse was capable of racing at his former level. The patency of the synthetic graft was 11 months.

[Veterinary dentistry (15). Apex resection in the horse]. / Veterinaire Tandheelkunde (15). Apexresectie bij het paard.

Periapical disorders in horses can be treated by resection of the apex. The indications, contraindications, diagnosis, treatment and complications of the intervention are discussed. Four case reports of horses in which apicoectomy with retrograde endodontic treatment was performed are reviewed.