Outcome following emergency laparotomy in 33 UK donkeys: A retrospective multicentre study.

BACKGROUND: Emergency laparotomies in donkeys are infrequently performed and there is limited literature on the subject. OBJECTIVES: To determine findings and associated outcomes of exploratory laparotomies in donkeys. STUDY DESIGN: Descriptive retrospective study. METHODS: Donkeys undergoing emergency exploratory laparotomy for investigation and treatment of colic at seven UK referral hospitals between 2005-2017 were included. Data were retrieved from available hospital records. Descriptive statistics and inferential statistical analysis of outcomes of interest was performed in three steps. RESULTS: Thirty-three cases fulfilled the inclusion criteria. Clinical signs on presentation were available for 32 donkeys, of which 53.1% (17/32) presented for investigation of colic while in 46.9% (15/32) the presenting complaint was non-specific. Primary lesion location included small intestine (42.4%, 14/33), large colon (39.3%, 13/33), caecum (6.1%, 2/33), stomach (6.1%, 2/33) and 6.1% (2/33) had multiple abnormal findings without a clear primary lesion. Overall survival to discharge was 54.5% (18/33). Five donkeys (15.2%, 5/33) were euthanased at surgery and of those recovering from general anaesthesia a further 35.7% (10/28) were euthanased or died prior to discharge. Six donkeys (21.4%, 6/28) required a second laparotomy of which 4 (66.7%, 4/6) survived. Post-operative complications occurred in 82.1% (23/28) of cases and included hyperlipaemia (42.9%, 12/28), incisional complications (21.4%, 6/28), ileus (21.4%, 6/28) and persistent colic (17.9%, 5/28). When adjusted for other complications, donkeys with primary gastric lesions were less likely to have presented with severe colic compared with those with primary small intestinal lesions (OR: 0.07, 95% CI 0.01-0.95, p = 0.05). Only age was positively associated with death prior to discharge (OR: 1.18, 95% CI 1.03-1.36, p = 0.02). MAIN LIMITATIONS: Small sample size and retrospective design. CONCLUSION: Donkeys with abdominal lesions may present with a range of signs often not including colic. Surgical findings were diverse and survival to discharge appears to be lower than in horses.

A shift towards early-age desexing of cats under veterinary care in Australia.

The global problem of unowned domestic cats, driven by their phenomenal reproductive success, carries significant economic, animal welfare and biodiversity costs. Desexing owned cats prior to puberty prevents unwanted litters that contribute to unowned cat populations. The prevalence and predictors of desexing, and the age at which surgery was carried out were investigated using anonymized electronic patient records in the VetCompass Australia database of cats presented to veterinary practices. Of 52,941 cats born between 2010 and 2017, 83.6% were desexed. Among 7463 desexed females, 21.5% had been desexed by 4 months of age, 59.8% by 6 months and 85.4% by 1 year. Sex, breed, location and socioeconomic indices significantly influenced desexing status and age at surgery. Cats born between 2010 and 2017 had greater odds of being desexed than cats born between 1995and 2009 at each age cut-off (≤ 4 months [OR 1.76, CI95 1.58-1.97], ≤ 6 months [OR 1.50, CI95 1.38-1.62] and ≤ 1 year [OR 2.33, CI95 2.11-2.57] p < 0.001). Most cats presented to veterinarians in Australia are desexed. Compared with cats born before 2010, cats born later are significantly younger at desexing but, even so, many cats would have reached sexual maturity before surgery. These findings will inform the design of front-line strategies promoting prepubertal desexing and they demonstrate, for the first time, a shift towards desexing younger cats.

A cross sectional study of psychotropic medicine use in Australia in 2018: A focus on polypharmacy.

AIMS: To examine prescribed psychotropic medicine use on a given day in Australia (25 September 2018; World Pharmacists Day), with a focus on psychotropic polypharmacy. METHODS: We used a 10% sample of individual-level nationwide dispensing claims to examine psychotropic medicine use on a given day. We estimated the prevalence of psychotropic medicine use in all ages stratified by age and sex. We also calculated the observed vs expected (had medicines been randomly combined) prevalence of psychotropic combinations used. We focused on combinations of clinical significance as well combinations of psychotropics with medicines prescribed to manage cardiovascular risk and disease. RESULTS: Serotonin reuptake inhibitors, serotonin-noradrenalin reuptake inhibitors/noradrenaline reuptake inhibitors, tricyclic antidepressants and gabapentinoids dominated psychotropic use. The use of any psychotropic as a proportion of people in the Australian population increased with age, peaking at the 85-89 year age group and declining thereafter. Combinations of medicines from the same subclass generally occurred at lower than expected frequencies. However, combinations including atypical antipsychotics occurred more frequently than expected; e.g. 7.4× with anticonvulsants and 2.2× with other atypical antipsychotics. This was also the case for combinations of sedatives, e.g. anxiolytic with hypnotic benzodiazepines (3.8×). Lipid-lowering drugs and antidiabetic medicines were combined with psychotropics at frequencies close to those expected had they been randomly combined. CONCLUSION: Psychotropic use in older adults and certain psychotropic combinations that are not well supported with evidence remain prevalent and greater consideration of the drivers of this potentially inappropriate prescribing is required.

Exercise-associated rhythm disturbances in poorly performing Thoroughbreds: risk factors and association with racing performance.

BACKGROUND: Exercise-associated cardiac rhythm disturbances are common, but there is a lack of evidence-based criteria on which to distinguish clinically relevant rhythm disturbances from those that are not. OBJECTIVES: To describe and characterise rhythm disturbances during clinical exercise testing; to explore potential risk factors for these rhythm disturbances and to determine whether they influenced future racing. STUDY DESIGN: Retrospective cohort using a convenience sample. METHODS: Medical records were reviewed from two clinical services to identify horses with poor performance and/or respiratory noise with both exercise endoscopy and electrocardiography results. Respiratory and ECG findings recorded by the attending clinicians were described, and for polymorphic ventricular rhythms (n = 12), a consensus team agreed the final rhythm characterisation. Several statistical models analysing risk factors were built and racing records were reviewed to compare horses with and without rhythm disturbance. RESULTS: Of 245 racehorses, 87 (35.5%) had no ectopic/re-entrant rhythms, 110 (44.9%) had isolated premature depolarisations during sinus rhythm and 48 (19.6%) horses had complex tachydysrrythmias. Rhythm disturbances were detected during warm-up in 20 horses (8.2%); during gallop in 61 horses (24.9%) and during recovery in 124 horses (50.6%). Most complex rhythm events occurred during recovery, but there was one horse with a single couplet during gallop and another with a triplet during gallop. Fifteen horses (one with frequent isolated premature depolarisations and 14 complex rhythms) were considered by clinicians to be potentially contributing to poor performance. Treadmill exercise tests, the presence of exercise-associated upper respiratory tract obstructions and National Hunt racehorses were associated with rhythm disturbances. The proportion of horses racing again after diagnosis (82%) was similar in all groups and univariable analysis revealed no significant associations between subsequent racing and the presence of any ectopic/re-entrant rhythm, or the various sub-groups based on phase of exercise in which this was detected. MAIN LIMITATIONS: Reliance on retrospective data collection from medical records with no control group. Exercise ECGs were collected using only 1 or 2 leads. Variables examined as risk factors could be considered to be inter-related and our sub-groups were small. CONCLUSIONS: This study confirms a high prevalence of cardiac rhythm disturbances, including complex ectopic/re-entrant rhythms, in poorly performing racehorses. Detection of rhythm disturbances may vary with exercise test conditions and exercise-associated upper respiratory tract obstructions increase the risk of rhythm disturbances.

A national study on prescribed medicine use in Australia on a typical day.

PURPOSE: To describe Australians' prescribed medicine use on a typical day (September 25, 2018). METHODS: We conducted a cross-sectional study using nationally representative dispensing claims data using the Australian Government Department of Human Services random 10% sample of all Australians eligible for prescription medicines subsidised through the Australian Pharmaceutical Benefits Scheme (PBS). Our main outcome measures were the number and proportion of people using at least one prescribed medicine and the specific medicine groups and classes on the day. We estimated the proportion of Australians using these medicines using the mid-year Australian population as the denominator. We quantified multiple medicine use by calculating the number and proportion of people experiencing polypharmacy (the use of 5 or more unique medicines) and hyper-polypharmacy (the use of 10 or more unique medicines). RESULTS: We found that 9.0 million Australians used at least one PBS medicine on September 25, 2018; equating to 27.5 million medicines in use across Australia. "Cardiovascular system", "nervous system" and "alimentary tract and metabolism" medicines comprised the top three medicine groups. Over 1.8 million people experienced polypharmacy on the day, accounting for 13.6 million dispensed medicines. 1 022 590 (45%) people aged ≥70 years old experienced polypharmacy and 188 930 (8%) experienced hyper-polypharmacy. CONCLUSIONS: Rates of polypharmacy were high, particularly in the people most susceptible to polypharmacy-related harm. Strategies to optimise the risk-benefit ratio of medicines and to reduce polypharmacy through "choosing wisely" and "de-prescribing" in this age group are needed. Australia's national data provides a benchmark to inform global medicine utilisation practices.

Career outcome of Thoroughbred racehorses with metacarpo/metatarsophalangeal joint dorsal chip fracture managed nonsurgically and surgically: A retrospective cohort study.

BACKGROUND: Arthroscopy has been advocated as the treatment of choice for dorsal osteochondral chip fracture of the metacarpo/metatarsophalangeal (MCP/MTP) joint. However, there is no published research on racing performance outcomes of horses with this pathology managed nonsurgically. OBJECTIVES: To compare racing career outcomes of Thoroughbred racehorses with nonsurgically (non-SX) or surgically (SX) managed MCP/MTP dorsal osteochondral chip fracture alongside a cohort of horses with no dorsal osteochondral chip fracture (unexposed). STUDY DESIGN: Retrospective cohort study conducted between 2006 and 2014. METHODS: Radiographs of Thoroughbred racehorses were reviewed to identify MCP/MTP dorsal osteochondral chip fractures. Unexposed horses under the care of the same practice were recruited randomly from training records. Racing outcomes were analysed using survival analysis and logistic, linear and negative binomial regression techniques. RESULTS: Dorsal osteochondral chip fractures were identified in 98 (70 non-SX, 28 SX) horses and compared with 648 unexposed horses. There was no significant difference among non-SX, SX, and unexposed horses in respect of total career starts, or likelihood of ever winning, placing, or earning money in a race (P > .05). SX horses had a significantly higher rate of wins/start than non-SX horses (rate ratio 1.6, CI 1.1-2.4, P = .02) and unexposed horses (rate ratio 1.9, CI 1.3-2.8, P = .001). Total career earnings for the SX horses were 4.1 times that of the unexposed horses (95% CI 1.2-14.5, P = .03), although total career earnings did not differ significantly between non-SX and unexposed horses (P = .8). MAIN LIMITATIONS: Retrospective observational study where management technique was not randomised or blinded. Small number of surgically managed horses and potential selection bias for surgical management. CONCLUSIONS: Nonsurgical management of this injury appears to be a valid management choice given that it was not associated with significant effects on racing career performance relative to a large unexposed cohort in this study population.

A systematic review of approaches to improve practice, detection and treatment of unhealthy alcohol use in primary health care: a role for continuous quality improvement.

BACKGROUND: Unhealthy alcohol use involves a spectrum from hazardous use (exceeding guidelines but no harms) through to alcohol dependence. Evidence-based management of unhealthy alcohol use in primary health care has been recommended since 1979. However, sustained and systematic implementation has proven challenging. The Continuing Quality Improvement (CQI) process is designed to enable services to detect barriers, then devise and implement changes, resulting in service improvements. METHODS: We conducted a systematic review of literature reporting on strategies to improve implementation of screening and interventions for unhealthy alcohol use in primary care (MEDLINE EMBASE, PsycINFO, CINAHL, the Australian Indigenous Health InfoNet). Additional inclusion criteria were: (1) pragmatic setting; (2) reporting original data; (3) quantitative outcomes related to provision of service or change in practice. We investigate the extent to which the three essential elements of CQI are being used (data-guided activities, considering local conditions; iterative development). We compare characteristics of programs that include these three elements with those that do not. We describe the types, organizational levels (e.g. health service, practice, clinician), duration of strategies, and their outcomes. RESULTS: Fifty-six papers representing 45 projects were included. Of these, 24 papers were randomized controlled trials, 12 controlled studies and 20 before/after and other designs. Most reported on strategies for improving implementation of screening and brief intervention. Only six addressed relapse prevention pharmacotherapies. Only five reported on patient outcomes and none showed significant improvement. The three essential CQI elements were clearly identifiable in 12 reports. More studies with three essential CQI elements had implementation and follow-up durations above the median; utilised multifaceted designs; targeted both practice and health system levels; improved screening and brief intervention than studies without the CQI elements. CONCLUSION: Utilizing CQI methods in implementation research would appear to be well-suited to drive improvements in service delivery for unhealthy alcohol use. However, the body of literature describing such studies is still small. More well-designed research, including hybrid studies of both implementation and patient outcomes, will be needed to draw clearer conclusions on the optimal approach for implementing screening and treatment for unhealthy alcohol use. (PROSPERO registration ID: CRD42018110475).

Paracetamol poisoning-related hospital admissions and deaths in Australia, 2004-2017.

OBJECTIVES: To assess the numbers of paracetamol overdose-related hospital admissions and deaths in Australia since 2007-08, and the overdose size of intentional paracetamol overdoses since 2004. DESIGN, SETTING: Retrospective analysis of data on paracetamol-related exposures, hospital admissions, and deaths from the Australian Institute of Health and Welfare National Hospital Morbidity Database (NHMD; 2007-08 to 2016-17), the New South Wales Poisons Information Centre (NSWPIC; 2004-2017), and the National Coronial Information System (NCIS; 2007-08 to 2016-17). PARTICIPANTS: People who took overdoses of paracetamol in single ingredient preparations. MAIN OUTCOME MEASURES: Annual numbers of reported paracetamol-related poisonings, hospital admissions, and deaths; number of tablets taken in overdoses. RESULTS: The NHMD included 95 668 admissions with paracetamol poisoning diagnoses (2007-08 to 2016-17); the annual number of cases increased by 44.3% during the study period (3.8% per year; 95% CI, 3.2-4.6%). Toxic liver disease was documented for 1816 of these patients; the annual number increased by 108% during the study period (7.7% per year; 95% CI, 6.0-9.5%). The NSWPIC database included 22 997 reports of intentional overdose with paracetamol (2004-2017); the annual number increased by 77.0% during the study period (3.3% per year; 95% CI, 2.5-4.2%). The median number of tablets taken increased from 15 (IQR, 10-24) in 2004 to 20 (IQR, 10-35) in 2017. Modified release paracetamol ingestion report numbers increased 38% between 2004 and 2017 (95% CI, 30-47%). 126 in-hospital deaths were recorded in the NHMD, and 205 deaths (in-hospital and out of hospital) in the NCIS, with no temporal trends. CONCLUSIONS: The frequency of paracetamol overdose-related hospital admissions has increased in Australia since 2004, and the rise is associated with greater numbers of liver injury diagnoses. Overdose size and the proportion of overdoses involving modified release paracetamol have each also increased.

Identification of Microchip Implantation Events for Dogs and Cats in the VetCompass Australia Database.

In Australia, compulsory microchipping legislation requires that animals are microchipped before sale or prior to 3 months in the Australian Capital Territory, New South Wales, Queensland and Victoria, and by 6 months in Western Australia and Tasmania. Describing the implementation of microchipping in animals allows the data guardians to identify individual animals presenting to differing veterinary practices over their lifetimes, and to evaluate compliance with legislation. VetCompass Australia (VCA) collates electronic patient records from primary care veterinary practices into a database for epidemiological studies. VCA is the largest companion animal clinical data repository of its kind in Australia, and is therefore the ideal resource to analyse microchip data as a permanent unique identifier of an animal. The current study examined the free-text 'examination record' field in the electronic patient records of 1000 randomly selected dogs and cats in the VCA database. This field may allow identification of the date of microchip implantation, enabling comparison with other date fields in the database, such as date of birth. The study revealed that the median age at implantation for dogs presented as individual patients, rather than among litters, was 74.4 days, significantly lower than for cats (127.0 days, p = 0.003). Further exploration into reasons for later microchipping in cats may be useful in aligning common practice with legislative requirements.

The relative lethal toxicity of pharmaceutical and illicit substances: A 16-year study of the Greater Newcastle Hunter Area, Australia.

AIMS: We aim to calculate 2 metrics of relative lethal toxicity; the fatal toxicity index (FTI; number of deaths per year of a daily dose) and the case fatality (CF; number of deaths per overdose) with a focus on opioids, antidepressants, antipsychotics, benzodiazepines and illicit drugs. METHODS: This descriptive cohort study used the Australian National Coronial Information System (NCIS) to identify a population of individuals with drug-associated deaths in the Greater Newcastle Hunter Area between January 2002 and December 2016. This was combined with Australian medicine dispensing data and corresponding data from the Hunter Area Toxicology Service to calculate FTI and CF. RESULTS: There were 444 drug-related deaths and 21,296 overdoses during the study period. FTI and CF were well correlated (Spearman's rho 0.64, P < .001). Of the classes of interest, opioids had the highest FTI (40.3 95% confidence interval [CI] 35.2-45.4 deaths per 100 years of use at the defined daily dose or deaths/DDD/100 years) and CF (12.4% 95%CI 11.0-13.9). Fentanyl, methadone and morphine had the highest relative fatal toxicity within this class. Tricyclic antidepressants had the highest relative fatal toxicity of all antidepressants (FTI 14.5 95%CI 9.7-19.3 deaths/DDD/100 years and CF 7.1% [95%CI 4.8-9.3]) and benzodiazepines appeared to be more associated with multiple agent deaths than single. Of the illicit drugs, heroin had the highest CF (26.4%, 95%CI 19.1-33.7). CONCLUSION: Knowledge of relative lethal toxicity is useful to prescribers and medicines and public health policy makers in restricting access to more toxic drugs and may also assist coroners in determining cause of death.

Airborne particulate size and concentrations in five Thoroughbred training yards in Newmarket (UK).

Despite their implication in the pathogenesis of lower airway inflammation, limited baseline data exists for airborne particulates in Thoroughbred racehorse stalls in the United Kingdom. This study documents airborne particulate size and concentrations in Newmarket training yards using a nephelometer (DustTrak DRX 8534, TSI). Each stall was sampled on a summer and winter day at three time points (morning, midday and evening). Minimum, mean and maximum/min ranges were calculated for the fraction of particulates with an aerodynamic diameter smaller than 2.5 µm (particulate matter (PM) 2.5) and 10 µm (PM10). Comparisons were made using Wilcoxon signed-rank test. Average particulate concentration ranges were 0.02-0.27 (summer) mg/m3, 0.01-0.37 (winter) mg/m3 for PM2.5 and 0.02-0.39 (summer) mg/m3, 0.02-0.60 (winter) mg/m3 for PM10. Statistically significant effects of season and time of day were established, resulting in implications for future studies investigating the effect of yard variables on airborne particulates.

Human exposures to veterinary pharmaceutical products reported to Australia's largest poison information centre.

Aim: To describe the epidemiology of veterinary pharmaceutical-related exposures based on telephone calls to Australia's largest poisons information centre. Methods: A retrospective analysis of exposures to pharmaceutical products intended for animal use, managed by the New South Wales Poison Information Centre (NSWPIC, Australia's largest poisons information centre) from 2014 to 2016 inclusive, was conducted. Case narratives were reviewed and coded for exposure-related circumstances and intended species. Descriptive statistics were generated and forest plots were produced to visualise the perceived severity of products. Results: From 2014 through 2016 NSWPIC received 2655 calls regarding exposure to veterinary pharmaceutical products: 11.72 human exposures to veterinary pharmaceuticals per 1000 PIC initial contact exposure calls (CI: 10.95-12.49) per year. The vast majority of exposures were with products intended for companion animals, particularly of the class "antiparasitic products, insecticides and repellents", with the most common individual specified product being pimobendan, a phosphodiesterase inhibitor used as a cardiac inotrope and vasodilator in dogs. Immunologicals presented the greatest perceived severity, with livestock vaccinations eliciting substantial proportions of symptomatic exposures and those receiving hospitalisation. Exploratory behaviour, such as accessing packaging, was a common source of exposure within toddlers and children in particular. Conclusions: This overview of all exposures to veterinary pharmaceutical products has identified high-risk groups to target interventions to reduce the incidence of future exposures. The pet-owning population and those personnel administering immunologicals to livestock represent a substantial cohort of individuals at risk of harm during, and in the immediate time following, administration of veterinary pharmaceutical products to animals. It is important to review risk management plans for veterinary pharmaceutical products to ensure product safety is as stringent as human equivalents. The legislative requirements concerning child-resistant packaging and the scheduling of livestock vaccines require reconsideration.

Systematic Review of the Efficacy and Safety of Gabapentin and Pregabalin for Pain in Children and Adolescents.

The barriers to opioid use in some countries necessitate the need to identify suitable alternatives or adjuncts for pain relief. The gabapentinoids (gabapentin and pregabalin) are approved for the management of persistent pain in adults, but not in children. Searches were conducted in Embase, Medline, Scopus, and Web of Science up until November 2017, for randomized controlled trials that investigated the analgesic effects of gabapentin or pregabalin in children and adolescents <18 years of age. A total of 7 publications were identified, 5 regarding gabapentin as prophylactic postsurgical pain relief for either adenotonsillectomy (n = 3) or scoliosis surgery (n = 2), and 1 for gabapentin treatment of chronic regional pain syndrome/neuropathic pain. One study investigated the efficacy of pregabalin as a treatment for fibromyalgia. Based on the studies' primary outcomes alone, neither of the chronic pain studies involving gabapentin and pregabalin showed significant efficacy compared with amitriptyline or placebo, respectively. Two of the prophylactic gabapentin studies for adenotonsillectomy and idiopathic scoliosis surgery reported significantly fewer children requiring analgesia and lower opioid requirement, respectively, compared with placebo. Two of the identified clinical trials (conducted by the same first author) on the efficacy of gabapentin for prophylactic postadenotonsillectomy pain relief were omitted from narrative synthesis due to clear evidence of fabricated data. Overall, this review identified a paucity of evidence for the analgesic effect and safety of gabapentinoids in children. We also suggest audit of any current evidence-based practice and clinical guidelines that have cited the research studies with fabricated data.

Arthroscopy of the Dorsal and Plantar Pouches of the Tarsocrural Joint for the Treatment of Osteochondritis Dissecans in the Horse: Clinical Features and Follow-Up.

OBJECTIVE: To describe the clinical details and pathology within the dorsal and plantar pouches of the tarsocrural joint of a population of horses that underwent arthroscopic surgery for tarsocrural osteochondritis dissecans (OCD). STUDY DESIGN: Retrospective cohort study. ANIMALS: Horses referred for arthroscopic treatment of tarsocrural OCD between 2005 and 2013 (102 horses; 144 joints). METHODS: Case records of all horses that had tarsocrural arthroscopy for OCD at Rossdales Equine Hospital, Newmarket, United Kingdom were included. Cases from 3 ECVS Diplomates were included, 1 of whom routinely examined 70 plantar pouches concurrently with routine dorsal pouch investigation. A structured questionnaire was used to obtain follow-up data alongside examination of racing records where appropriate. Descriptive data and 95% CI were calculated. RESULTS: Of the 70 joints that had both dorsal and plantar pouches examined, there was cartilage erosion/degeneration in 22 dorsal pouches (31.4%), cartilage wear lines in 32 plantar pouches (45.7%), and fragments were removed at the time of surgery from 7 plantar pouches (10.0%). Of the plantar pouches with wear lines, 18 (25.7%) had no evidence of cartilage abnormalities (separate from the OCD lesion) within the dorsal pouch. From the 102 horses with available follow-up, 34 horses (66.7%) achieved their intended use postsurgery. CONCLUSION: Routine plantar pouch investigation is warranted in cases of tarsocrural OCD to provide further information on the health of the joint and allows for removal of fragments from the plantar pouch that may not have been identified by routine diagnostic radiography.

Mineralization of the Equine Palmar/Plantar Annular Ligament Treated by Surgical Resection.

OBJECTIVE: To document the clinical presentation, diagnosis, and surgical treatment of mineralization of the equine palmar/plantar annular ligament (PAL). STUDY DESIGN: Retrospective study. ANIMALS: Ponies (n=7). METHODS: Case records from 2 referral hospitals were examined to identify cases with lameness associated with PAL mineralization treated surgically. Follow-up information was obtained from the owners by telephone questionnaire. RESULTS: Duration of lameness before referral ranged from 5 weeks to 6 months, and degree of lameness from grade 1 to 5 out of 10. In 3 cases, records noted obvious pain when pressure was applied over the PAL. Pain resulting in lameness was localized to this area and all cases were treated surgically, although the extent of resected tissue varied among cases. Histological examination of resected tissue (4 cases) revealed fibrocartilaginous and/or osseous metaplasia. Following surgery, 6 of the 7 ponies became sound. CONCLUSION: Based on this limited case series, surgical treatment for mineralization of the PAL offers a favorable success rate without severe complications where conservative methods have failed.

Alleviation of Epiphora by Canaliculosinostomy into the Caudal Maxillary Sinus in the Horse.

OBJECTIVE: To describe a technique of canaliculosinostomy into the caudal maxillary sinus to alleviate epiphora secondary to nasolacrimal duct obstruction and to report the long-term outcome in 5 horses. STUDY DESIGN: Case series. ANIMALS: Five client-owned horses. METHODS: Case records of all horses presented for chronic epiphora to a single equine hospital that underwent surgical treatment were reviewed. All included horses had a Jones test or dacryocystography to confirm nasolacrimal duct obstruction. All horses were anesthetized and canaliculosinostomy was created from the medial canthus of the eye into the caudal maxillary sinus using a Steinmann pin and Jacob's chuck. A Foley catheter was placed normograde through the stoma. The inflated bulb held the Foley in place in the sinus, while the proximal end was pulled through the upper eyelid and sutured to the skin on the head. The Foley catheter was maintained in place for 3 weeks and then removed under sedation. RESULTS: Five horses were included. There were no intraoperative difficulties or complications. One horse dislodged the Foley catheter 3 days postoperatively. No other postoperative complications occurred. Followup was available for all horses. One horse was euthanatized for unrelated reasons 10 weeks postoperative at which time epiphora was resolved. The remaining 4 horses had resolution of epiphora at followup (24-46 months postoperative). CONCLUSION: This report describes a simple technique for canaliculosinostomy into the caudal maxillary sinus and long-term outcome in 4 of 5 horses, all of which had resolution of epiphora. This technique can be used to resolve epiphora of various etiologies.