Survey of equine castration techniques, preferences and outcomes among Australian veterinarians.

OBJECTIVES: (1) To collect the perceptions of veterinarians performing equine castrations in Australia on techniques, preferences and outcomes, (2) to investigate veterinarian use and experience with the Henderson castrating instrument and (3) to investigate potential associations between demographics, castration methods and techniques, and complications. DESIGN: Online survey of members of the Australian Veterinary Association's Special Interest Group, Equine Veterinarians Australia (EVA). METHODS: A link to the survey was included in the EVA e-newsletter and practices on the EVA website were contacted by telephone and follow-up email. Fisher's exact test was used to determine associations between ligation and complications. A generalised linear model with a negative binomial family was used to determine associations between count response variables and categorical independent variables. RESULTS: Responses were obtained from 138 veterinarians (response rate, 13.1%) who performed 5330 castrations over 12 months. Castrations were most commonly performed in the field, on anaesthetised horses, using emasculators, via an open approach and without ligation of the spermatic cord. Estimated complications after use of emasculators were swelling (25%), haemorrhage (5%) and infection (5%). The Henderson instrument was used by approximately 10% of respondents and its use for castration was associated with fewer reports of postoperative swelling compared with emasculators (P = 0.002). Rates of evisceration with the Henderson and emasculator methods were comparable (0.43% and 0.9%, respectively). CONCLUSION: Castration preferences varied widely among survey participants. Reported complication types and rates were comparable to those reported previously in other countries. Perceptions that the Henderson instrument was associated with less swelling should be investigated further via a prospective controlled investigation.

Assessing drug elution technologies in the superficial femoral artery.

The endovascular management of symptomatic atherosclerotic superficial femoral artery (SFA) disease is challenging and requires consideration of unique anatomical, hemodynamic, and biomechanical factors. The current armamentarium of balloon catheters and flexible nitinol bare metal stents have limited long-term efficacy due to intimal hyperplasia resulting in restenosis. Unfortunately, the remarkably low restenosis rates achieved with drug eluting stents placed in the coronary vasculature has not been replicated in the femoral artery. The reason for this is multifactorial including delivery platforms, drug and dosage selection and trial design flaws. Currently, however, there are several novel therapies and delivery platforms in the development pipeline that have exhibited biologic effectiveness in preclinical and early clinical trials. While these offer promise in improving outcomes following lower extremity intervention, caution is warranted until the safety of these new technologies can be ensured.

Surgical site infections: epidemiology, microbiology and prevention.

Surgical site infections (SSIs) are defined as infections occurring up to 30 days after surgery (or up to one year after surgery in patients receiving implants) and affecting either the incision or deep tissue at the operation site. Despite improvements in prevention, SSIs remain a significant clinical problem as they are associated with substantial mortality and morbidity and impose severe demands on healthcare resources. The incidence of SSIs may be as high as 20%, depending on the surgical procedure, the surveillance criteria used, and the quality of data collection. In many SSIs, the responsible pathogens originate from the patient's endogenous flora. The causative pathogens depend on the type of surgery; the most commonly isolated organisms are Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus spp. and Escherichia coli. Numerous patient-related and procedure-related factors influence the risk of SSI, and hence prevention requires a 'bundle' approach, with systematic attention to multiple risk factors, in order to reduce the risk of bacterial contamination and improve the patient's defences. The Centers for Disease Control and Prevention guidelines for the prevention of SSIs emphasise the importance of good patient preparation, aseptic practice, and attention to surgical technique; antimicrobial prophylaxis is also indicated in specific circumstances. Emerging technologies, such as microbial sealants, offer the ability to seal and immobilise skin flora for the duration of a surgical procedure; a strong case therefore exists for evaluating such technologies and implementing them into routine clinical practice as appropriate.