Lamprey gonadotropin-releasing hormone-III selectively releases follicle stimulating hormone in the bovine.

Recent studies have shown that lamprey gonadotropin-releasing hormone (l-GnRH) is localized in the mammalian brain, and that l-GnRH-III, can selectively induce FSH secretion in the rat both in vivo and in vitro. Consequently, the purpose of this study was to determine if l-GnRH-III could elicit selective FSH release in cattle and compare this response with that to mammalian luteinizing hormone releasing hormone (m-LHRH). Cattle were chosen as the animal model because previous studies have demonstrated that FSH and LH are secreted by separate gonadotropes in that species. For these studies, crossbred cycling heifers were implanted with jugular cannulae and l-GnRH-III was infused either between Days 9-14 or on Day 20 of the estrous cycle. Blood samples were collected both before and following peptide infusion. Our results demonstrate that during Days 9-14 of the estrous cycle (luteal phase), when progesterone levels averaged between 4 and 5 ng/ml, a dose of 0.25 mg of l-GnRH-III induced the release of FSH (P < 0.05), but not LH. A 0.5 mg dose of l-GnRH-III caused a greater release of FSH (P < 0.01), but still did not induce LH release. Higher doses of the peptide were capable of significantly releasing both gonadotropins. Importantly, during the luteal phase, doses of 0.5 and 2 mg of m-LHRH were ineffective in stimulating FSH, but did elicit marked increases (P < 0.001) in LH. Again, progesterone levels averaged 4-5 pg/ml. In order to assess gonadotropin releasing ability of l-GnRH-III at a different phase of the estrous cycle, some animals were administered the peptide on Day 20, when progesterone levels were below 1.0 pg/ml. At this time, the l-GnRH-III induced the release of LH (P < 0.01), but not FSH. Overall, our results demonstrate that l-GnRH-III can selectively induce FSH in cattle during the luteal phase, whereas m-LHRH was ineffective in that regard. Furthermore, the fact that l-GnRH-III can selectively stimulate FSH when serum progesterone is high, and LH when serum progesterone is low, suggests its actions are under strong control of this steroid. We suggest the FSH releasing capacity of l-GnRH-III in cattle could render this peptide useful for enhancement of reproductive efficiency in this species.

Risk factors associated with development of postoperative ileus in horses.

OBJECTIVE: To determine risk factors associated with development of postoperative ileus in horses undergoing surgery for colic. DESIGN: Case-control study. ANIMALS: 69 horses that developed ileus after surgery for colic and 307 horses that did not develop postoperative ileus. PROCEDURE: Signalment, history, clinicopathologic data, treatment, lesions, and outcome were obtained from medical records. RESULTS: Variables associated with increased risk of postoperative ileus included age > 10 years, Arabian breed, PCV > or = 45%, high serum concentrations of protein and albumin, anesthesia > 2.5 hours' duration, surgery > 2 hours' duration, resection and anastomosis, and lesions in the small intestine. Enterotomy reduced the risk of postoperative ileus. After multivariate logistic regression, the final model included the variables Arabian breed, PCV > or = 45%, lesion type, duration of surgery (> 2 hours vs < or = 2 hours), and pelvic flexure enterotomy. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that by evaluating certain factors, horses at increased risk of postoperative ileus may be recognized before the condition develops. Preventative treatment and early intervention may be instituted in these horses. Shortening surgery time and performing an enterotomy may decrease the probability of horses developing postoperative ileus.

Prokinetic effects of erythromycin on the ileum, cecum, and pelvic flexure of horses during the postoperative period.

OBJECTIVE: To evaluate the effect of erythromycin on motility of the ileum, cecum, and pelvic flexure of horses during the postoperative and post-recovery periods. ANIMALS: 8 healthy adult horses. PROCEDURE: Horses were anesthetized and bipolar electrodes were implanted in smooth muscle of the ileum, cecum, and pelvic flexure. Approximately 4, 16, and 24 hours (postoperative recording sessions) and at least 8 days (post-recovery recording session) after surgery, myoelectric activity was recorded before and after administration of erythromycin (0.5 mg/kg). RESULTS: Following erythromycin administration, myoelectric activity was increased in the ileum during all postoperative recording sessions but not during the post-recovery recording session. Myoelectric activity was increased in the cecum following erythromycin administration only during the post-recovery recording session. Myoelectric activity was increased in the pelvic flexure following erythromycin administration during all recording sessions. During several recording sessions, there were short periods during which myoelectric activity was significantly decreased following erythromycin administration. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that erythromycin has an effect on myoelectric activity of the ileum, cecum, and pelvic flexure in horses; however, prokinetic effects of erythromycin administered during the postoperative period were not always the same as effects obtained when the drug was administered after horses had recovered from the effects of surgical implantation of recording devices. Therefore, caution must be exercised when extrapolating results of prokinetic studies in healthy animals to animals with abnormal gastrointestinal tract motility.

Abomasal displacement and volvulus in beef cattle: 19 cases (1988-1998).

OBJECTIVE: To assess signalment, history, results of clinical and laboratory testing, and outcome for beef cattle with a left displaced abomasum (LDA), right displaced abomasum (RDA), or abomasal volvulus (AV). DESIGN: Retrospective study. ANIMALS: 19 beef cattle with an AV, LDA, or RDA. PROCEDURE: Signalment; history; results of physical examination, diagnostic testing, and surgical exploration; and condition of the animal at discharge were obtained from medical records. RESULTS: Fourteen cattle had an AV, 4 had an RDA, and 1 had an LDA. Duration of clinical signs ranged from 1 to 21 days. Eighteen cattle had an AV or RDA; 7 were Brahmans, 12 were males, and median age was 10 months. Abdominal distention was observed in 11 cattle, heart rate of > or = 100 beats/minute was detected in 14, and the abomasum was palpable per rectum in all cattle in which per rectal examination was performed. Leukocytosis, neutrophilia, hyperglycemia, azotemia, hypochloremia, and hypokalemia were common laboratory findings. At surgery, 3 cattle with an AV or RDA had a ruptured abomasum. Of the remaining 15 cattle, 12 survived. CONCLUSIONS: Clinical course in beef cattle with an AV or RDA was more protracted than that typically associated with these conditions in dairy cattle, but survival rate in beef cattle that did not have rupture of the abomasum was similar to that of dairy cattle. CLINICAL RELEVANCE: Abomasal displacement should be considered for beef cattle with abdominal distention. Prognostic indicators recommended for use in dairy cattle may not be useful for beef cattle.

Pharmacokinetics of fentanyl after intravenous and transdermal administration in goats.

OBJECTIVE: To evaluate disposition of fentanyl in goats after IV and transdermal administration. ANIMALS: 8 healthy 2-year-old goats weighing 31.8 to 53.6 kg (mean+/-SD, 40.4+/-7.5 kg). PROCEDURE: Each goat was given 2 treatments consisting of fentanyl administered IV (2.5 microg/kg of body weight) and via a transdermal patch (50 microg/h). There was a 2-month interval between treatments. Blood samples were collected at specified times and analyzed in duplicate to determine plasma fentanyl concentrations. Pharmacokinetic values were calculated, using a computerized modeling program. RESULTS: Administration of fentanyl was tolerated by all goats. Intravenous administration of fentanyl resulted in a transitory increase in rectal temperature that was not clinically important. Terminal elimination half-life after IV administration was 1.20+/-0.78 h, volume of distribution at steady state was 1.51+/-0.39 L/kg, and systemic clearance was 2.09+/-0.62 L/kg/h. Transdermal administration of fentanyl resulted in variable plasma concentrations, with peak plasma concentrations ranging from 1.12 to 16.69 ng/ml (mean+/-SD, 6.99+/-6.03 ng/ml) and time to peak concentration ranging from 8 to 18 hours (mean+/-SD, 13+/-4.5 hours). After removal of the transdermal patch, mean+/-SD terminal elimination half-life was 5.34+/-5.34 hours. CONCLUSIONS AND CLINICAL RELEVANCE: Intravenous administration of fentanyl (2.5 microg/kg) in goats results in a relatively short half-life that will limit its use for management of pain. Transdermal administration of fentanyl (50 microg/h) in goats results in variable plasma concentrations that may exceed those anticipated on the basis of a theoretical delivery rate, but stable plasma concentrations of fentanyl may not be achieved.

Maintenance of anaesthesia with sevoflurane and oxygen in mechanically-ventilated horses subjected to exploratory laparotomy treated with intra- and post operative anaesthetic adjuncts.

Eight healthy horses premedicated with xylazine and induced with ketamine were used to evaluate sevoflurane in oxygen for maintenance of anaesthesia during elective exploratory laparotomy. After orotracheal intubation, horses were hoisted, placed in dorsal recumbency on a padded surgery table, and received sevoflurane in oxygen for maintenance of anaesthesia. The horses were allowed to breathe spontaneously until instrumented; then, they were mechanically ventilated to maintain the PaCO2 between 35 and 45 mmHg. Systolic (SAP), diastolic (DAP), and mean (MAP) arterial blood pressures, heart rate (HR), ECG, respiratory rate, an estimation of the saturation of haemoglobin with oxygen in peripheral arterial blood (S(p)O2), nasal temperature, end-tidal CO2(ET(CO2)), end-tidal sevoflurane (ET(SEVO)), and vaporiser concentration were recorded every 5 min post induction; arterial blood samples were obtained soon after induction, at 30 min after induction, and every hour thereafter until surgery was completed. Recovery data including times from the sevoflurane vaporiser being turned off to first movement, to sternal recumbency, and to standing, number of attempts to stand, and recovery score (between 1 = safe, smooth and 6 = stormy, major injury to horse) were collected. Analysis of variance was performed using physiological data collected over 195 min of anaesthesia, the longest time period during which all 8 horses were instrumented. Time effects (P<0.05) for HR, SAP, DAP, MAP, and nasal temperature were identified. Heart rate peaked at 45 min and declined over the course of the procedure. Arterial blood pressure generally decreased over time. Body temperature decreased over time. From 15 to 195 min mean ET(SEVO)concentration ranged from 2.0 to 3.3%, while mean vaporiser settings ranged from 3.7 to 5.5%. Three horses received intra-operative ketamine; all horses received dobutamine infusions; and 2 horses received intra-operative calcium-dextrose. Total anaesthesia time was 222-316 min (mean+/-s.d.269+/-31 min). Time from turning the sevoflurane vaporiser off to first movement was mean +/-s.d.18+/-15 min; to sternal recumbency was 54+/-22 min; to standing was 65+/-27 min; and to returning the horse to the stall in the ward was 78+/-24 min. Six horses stood on the first attempt; 2 horses stood on the second attempt. The median recovery score was one (1-3). In conclusion, sevoflurane provided a stable, easily controllable anaesthetic plane during prolonged exploratory laparotomies; horses experienced smooth, safe recoveries after maintenance of anaesthesia with sevoflurane following routine anaesthetic induction and post operative xyalzine administration.

Alterations in acid-base balance and serum electrolyte concentrations in cattle: 632 cases (1984-1994).

OBJECTIVE: To determine typical alterations in acid-base balance and serum electrolyte concentrations in cattle grouped on the basis of age, breed type, hydration status, clinical signs, and underlying disease. DESIGN: Retrospective study. ANIMALS: 632 cattle. PROCEDURE: Information on blood pH, PVO2, PVCO2, HCO3-concentration, and base excess (BE) as well as serum or plasma sodium, potassium, chloride, and total carbon dioxide concentrations was obtained. Values for calves (ie, cattle < 1 month old) were compared with values for cattle > or = 1 month old. Within each age-group, values were compared for cattle grouped on the basis of breed type, previous treatment, and hydration status. Proportions of cattle with various disorders for which values were within, greater than, or less than reference ranges were determined. RESULTS: BE, pH, and HCO3- concentration were significantly higher and PVCO2 and sodium, potassium, and chloride concentrations were significantly lower among cattle > or = 1 month old than calves. Base excess and HCO3- concentration were significantly lower among dairy than beef calves. Sodium and potassium concentrations were significantly lower among dairy than beef cattle > or = 1 month old. A higher proportion of cattle that did not survive had a high anion gap than cattle that did survive. Sodium, potassium, and chloride concentrations were significantly lower among dehydrated cattle than cattle that were not dehydrated. CLINICAL IMPLICATIONS: Because certain alterations were consistently found in some groups of cattle, it may be possible to make reasonable predictions of alterations in acid-base balance and serum electrolyte concentrations when laboratory evaluations are not available.

Detomidine-butorphanol-propofol for carotid artery translocation and castration or ovariectomy in goats.

OBJECTIVE: To determine the safety and efficacy of propofol, after detomidine-butorphanol premedication, for induction and anesthetic maintenance for carotid artery translocation and castration or ovariectomy in goats. STUDY DESIGN: Case series. ANIMALS: Nine 4-month-old Spanish goats (17.1 +/- 2.6 kg) were used to evaluate propofol anesthesia for carotid artery translocation and castration or ovariectomy. METHODS: Goats were premedicated with detomidine (10 micrograms/kg intramuscularly [i.m.]) and butorphanol (0.1 mg/kg i.m.) and induced with an initial bolus of propofol (3 to 4 mg/kg intravenously [i.v.]). If necessary for intubation, additional propofol was given in 5-mg (i.v.) increments. Propofol infusion (0.3 mg/kg/min i.v.) was used to maintain anesthesia, and oxygen was insufflated (5 L/min). The infusion rate was adjusted to maintain an acceptable anesthetic plane as determined by movement, muscle relaxation, ocular signs, response to surgery, and cardiopulmonary responses. Systolic (SAP), mean (MAP) and diastolic (DAP) arterial pressures, heart rate (HR), ECG, respiratory rate (RR), SpO2, and rectal temperature (T) were recorded every 5 minutes postinduction; arterial blood gas samples were collected every 15 minutes. Normally distributed data are represented as mean +/- SD; other data are medians (range). RESULTS: Propofol (4.3 +/- 0.9 mg/kg/min i.v.) produced smooth, rapid (15.2 +/- 6 sec) sternal recumbency. Propofol infusion (0.52 +/- 0.11 mg/kg/min i.v.) maintained anesthesia. Mean anesthesia time was 83 +/- 15 minutes. Muscle relaxation was good; eye signs indicated surgical anesthesia; two goats moved before surgery began; one goat moved twice during laparotomy. Means are reported over the course of the data collection period. Means during the anesthesia for pHa (arterial PH), PaCO2, PaO2, HCO3-, and BE (base excess) ranged from 7.233 +/- 0.067 to 7.319 +/- 0.026, 54.1 +/- 4.6 to 65.3 +/- 12.0 mm Hg, 133.1 +/- 45.4 to 183.8 +/- 75.1 mm Hg, 26.9 +/- 2.6 to 28.2 +/- 2.1 mEq/L, and -0.8 +/- 2.9 to 1.4 +/- 2.2 mEq/L. Means over time for MAP were 53 +/- 12 to 85 +/- 21 mm Hg. Mean HR varied over time from 81 +/- 6 to 91 +/- 11 beats/minute; mean RR, from 9 +/- 8 to 15 +/- 5 breaths/minute; SpO2 from 97 +/- 3% to 98 +/- 3%; mean T, from 36.0 +/- 0.6 degrees C to 39.1 +/- 0.7 degrees C. Over time, SpO2 and SaO2 did not change significantly; HR, RR, T, and PaCO2 decreased significantly; SAP, DAP, MAP, pHa, PaO2, and BE increased significantly. HCO3- concentrations increased significantly, peaking at 45 minutes. Recoveries were smooth and rapid; the time from the end of propofol infusion to extubation was 7.3 +/- 3 minutes, to sternal was 9.2 +/- 5 minutes, and to standing was 17.7 +/- 4 minutes. Median number of attempts to stand was two (range of one to four). Postoperative pain was mild to moderate. CONCLUSIONS: Detomidine-butorphanol-propofol provided good anesthesia for carotid artery translocation and neutering in goats. CLINICAL RELEVANCE: Detomidine-butorphanol-propofol anesthesia with oxygen insufflation may be safely used for surgical intervention in healthy goats.

Cost-effectiveness analysis of treatment alternatives for beef bulls with preputial prolapse.

OBJECTIVE: To develop an economic model for comparing cost-effectiveness of medical and surgical treatment versus replacement of beef bulls with preputial prolapse. DESIGN: Economic analysis. SAMPLE POPULATION: Estimates determined from medical records of bulls treated for preputial prolapse at our hospital and from information about treatment of bulls published elsewhere. PROCEDURE: Annual depreciation cost for treatment (ADC(T)) and replacement (ADC(R)) were calculated. Total investment for an injured bull equaled the sum of salvage value, maintenance cost, and expected cost of the treatment option under consideration. Total investment for a replacement bull was purchase price. Net present value of cost was calculated for each year of bull use. Sensitivity analyses were constructed to determine the value that would warrant treatment of an injured bull. RESULTS: The decision to treat was indicated when ADC(T) was less than ADC(R). In our example, it was more cost-effective for owners to cull an injured bull. The ADC(R) was $97 less than ADC(T) for medical treatment ($365 vs $462) and $280 less than ADC(T) for surgical treatment ($365 vs $645). Likewise, net present value of cost values indicated that it was more cost-effective for owners to cull an injured bull. Sensitivity analysis indicated treatment decisions were justified on the basis of replacement value or planned number of breeding seasons remaining for the bull. CLINICAL IMPLICATIONS: The model described here can be used by practitioners to provide an objective basis to guide decision making of owners who seek advice on whether to treat or replace bulls with preputial prolapse.

Ablation of the cranial portion of the preputial cavity in a pig.

A technique for surgical ablation of the cranial portion of the preputial cavity including the preputial diverticulum in pigs is described. The technique was performed on a 5-month-old 83.2-kg (183-lb) Hampshire barrow that had ulceration and fibrosis of the preputial cavity secondary to chronic preputial diverticulitis. The pig recovered without difficulties and was able to urinate normally after surgery.

Tension band plating of an olecranon fracture in a bull.

A 1,018-kg (2,240-lb), 6-year-old bull was admitted for evaluation of a left forelimb lameness of 7 days' duration. Radiographic views of the proximal portion of the left forelimb revealed a type-III olecranon fracture that was minimally displaced. Conservative treatment, including stall confinement and administration of anti-inflammatory drugs, was attempted. Subsequent radiographic views, 27 days later, revealed displacement of the fracture with minimal callus formation. Open reduction and internal fixation was performed by placing a 4.5-mm, 10-hole broad dynamic-compression on the caudal surface of the olecranon. Good anatomic reduction was achieved, returning the bull to full weightbearing. Eight months following surgery the owners reported the bull was sound at a walk and able to breed cows.

Cosmetic dehorning in goats.

OBJECTIVE: This article describes a technique using primary closure when dehorning goats, and report the results of 22 cases. STUDY DESIGN: Medical records of goats that had cosmetic dehorning were reviewed. ANIMALS OR SAMPLE POPULATION: Twenty-two goats. METHODS: The medical records of 22 goats, not previously dehorned by other methods, that were cosmetically dehorned between January 1988 and September 1995 were reviewed. Data retrieved from the medical record included age, breed, sex, surgical technique used for dehorning, and any complications that occurred after surgery. All clients were contacted by telephone to determine the course of postoperative healing for each goat. A surgical technique to remove the horns and close the defect primarily was described. RESULTS: The mean age of the goats, all male Nubian or Nubian-Spanish cross, was 6.9 months (range, 2 to 24 months). Horn base diameter ranged from approximately 2 to 4 cm. Mean time from surgery until follow-up was 12.9 months (range, 3 to 57 months). All incisions healed by first intention in 10 to 14 days. Clinical signs of sinusitis were not noted, and owners were pleased with the healing time and cosmetic result obtained. CONCLUSIONS: Primary closure of skin defects after dehorning of goats can be achieved with minimal postoperative care and excellent cosmetic appearance. CLINICAL RELEVANCE: Primary closure after dehorning in mature goats reduces aftercare.

Catheterization of the auricular vein in cattle: 68 cases (1991-1994).

OBJECTIVE: To evaluate the use of auricular vein catheters (AVC) in cattle in a clinical setting. DESIGN: Case series. ANIMALS: 57 cattle. PROCEDURE: 68 AVC were placed in cattle for the administration of drugs or rehydration fluids. Catheter size, quantity of fluids administered, duration of administration, drugs administered, duration of catheter maintenance, and problems were recorded. RESULTS: The AVC ranged in size from 20 to 14 gauge, with the latter being the predominate size. A maximum flow rate of 7.7 L/h was achieved, and the flow rate was satisfactory in all but 1 case. The maximum duration of maintenance was > 96 hours. Problems occurred in 29 of 68 (43%) catheterizations; the most frequent problem was occlusion of the catheter, which occurred 16 times (24%). No serious complications occurred. CLINICAL IMPLICATIONS: Auricular vein catheters were a convenient, safe, and low-cost alternative to jugular vein catheters.

Urinary surgery.

This article describes diagnosis, prognosis, pathophysiology, and methods to surgically correct abnormalities of the urinary system of ruminants. Surgery of the urinary system in ruminants most frequently is required to alleviate urethral obstruction or correct urinary bladder rupture. Several options for surgical management of those conditions are presented, but the prognosis for long-term survival or a return to reproductive function is poor if a urethrostomy is performed. Nephrectomy, translocation of ectopic ureters, removal of urachal remnants, and urethral extension to treat urovagina are performed less often in ruminants because animals requiring these procedures often are culled because of economic considerations or decreased productivity. Consequently, much of what has been described for ruminants is based on a limited number of cases or extrapolated from what has been learned from other species.

Case-control study of the association between various management factors and development of colic in horses. Texas Equine Colic Study Group.

The association between various management factors and development of colic was studied in 821 horses treated for colic and 821 control horses treated for noncolic emergencies by practicing veterinarians in Texas between Oct 1, 1991 and Dec 31, 1992. History of previous colic and history of previous abdominal surgery were found to be significantly associated with colic. Change in stabling conditions during the 2 weeks prior to the time of examination, recent change in diet, and recent change in level of activity significantly increased the risk for development of colic. Changes in activity level, diet, and stabling conditions were identified as potentially alterable risk factors for colic. Logistic regression was used to adjust for the effects of all variables found to be significantly associated with colic by means of univariate analysis, and only history of previous colic, history of previous abdominal surgery, and history of recent change in diet remained significantly associated with colic. Results of this study indicate that a proportion of colic cases might be prevented by minimizing changes in management practices.

Ventral pararectal approach to the seminal vesicles of bulls.

Results of bilateral seminal vesiculectomy on 4 clinically normal bulls indicated that a ventral pararectal approach can be done to gain exposure to the seminal vesicles without excessive risk of postoperative complications or alterations in the bull's ability to develop and maintain an erection or to ejaculate semen. Advantages of the ventral pararectal approach over the lateral approach to the seminal vesicles are that all dissection is on the midline between the rectum and pelvic urethra and the prevalence of intraoperative hemorrhage and postoperative hematoma formation is decreased. Additionally, the potential to damage nerves that lie adjacent to the rectum and pelvic urethra is reduced. Consequently, bladder atony and ejaculatory failure are less likely to develop after seminal vesiculectomy via a ventral pararectal approach.

Effects of bilateral ovariectomy via colpotomy in mares: 23 cases (1984-1990).

Postoperative performance and behavioral patterns were investigated retrospectively in 23 client-owned mares after bilateral ovariectomy via colpotomy. The interval from surgery to postoperative inquiries ranged from 9 to 67 months. Information obtained from review of the medical record and client interviews included the reason for ovariectomy, postoperative complications, problems identified by owners after discharge of the mare from the hospital, postoperative level of athletic performance, postoperative signs of estrus, and overall owner satisfaction. Reasons given by owners for having mares ovariectomized were behavioral modification (16 mares), use as embryo-transfer recipients (3 mares), use as mount mares for collecting semen (2 mares), elimination of chronic colic during estrus (1 mare), and sterilization for registration (1 mare). Postoperative complications developed in 4% (1/23) of the mares; however, problems were noticed by the owners of 4 other mares after discharge from the hospital. Continuing signs of behavioral estrus were detected in 35% (8/23) of the mares, but in only in 9% (2/23) was the behavior judged to be objectionable by the owner. Of 12 mares used in performance events prior to bilateral ovariectomy, 10 were judged to be competing at greater than preoperative levels, 1 was judged to be competing at the same level, and 1 was judged to be competing at less than preoperative level of performance. Of 18 owners, 14 were satisfied, 2 were undecided, and 2 were dissatisfied with their mare after it had had bilateral ovariectomy.

Intermittent antimicrobial infusion for management of a septic distal interphalangeal joint in a horse.

A 13-month-old Quarter Horse colt sustained a puncture wound to the frog region of the foot, which penetrated the navicular bursa and distal interphalangeal joint, 7 days prior to examination. A street-nail procedure was performed to debride the tract and provide drainage of the navicular bursa and distal interphalangeal joint. An indwelling lavage system was placed through the dorsal aspect of the joint and antimicrobials were infused intermittently to supply a high local concentration of drug and to frequently lavage the distal interphalangeal joint and navicular bursa.