Unicameral Bone Cyst in the Proximal Humerus with Secondary Infection in an 18 -Month-Old Foal

An 18-month-old warmblood filly was 4/5 lame on the front right limb at referral and showed severe swelling of the right shoulder region and pain during manipulation of the shoulder region. Radiography revealed a roundish 5 × 7 cm radiolucent area with defined borders within the greater tubercle and the presence of a fracture of the lateral tubercle associated with the cyst. Cellular blood count was 27,500 WBC/μL and serum biochemical analyses revealed fibrinogen of 855 mg/dL. The fractured bone was removed surgically; the cyst debrided and filled with autologous cancellous bone graft. Three and five weeks after surgery the filly was reoperated on because of an osseous sequestrum and a periostal defect on the distal dorsolateral aspect of the pastern of the right hind limb and a septic synovitis of the DFTS of the left hind limb. Fifteen month after surgery the filly was not lame and was introduced to training. Unicameral bone cysts (UBC) are well described lesions, often associated to pathologic fracture in the proximal humerus of children but, until present, no scientific report exists of UBC in the foal. The prompt surgical management had a favorable outcome

Reporting of anaesthesia and pain management in preclinical large animal models of articular cartilage repair - A long way to go

Animal models continue to be used to investigate cartilage repair strategies. Adequate anaesthesia and pain management are essential in order to guarantee acceptable animal welfare as well as reproducible experimental results. This systematic review evaluates reporting of anaesthesia and pain management in surgical large animal models (horse, pig, dog, goat and sheep) of (osteo)chondral repair. Manuscripts published between 2015 and 2020 were included after a comprehensive search strategy. Data were evaluated using descriptive statistics and qualitative review. Out of 223 eligible studies, 220 studies contained incomplete information on anaesthetic and pain management. Pre-, intra- and post-operative analgesia were not mentioned in 68%, 94%, and 64% of manuscripts respectively. A total of 176 studies reported that animals underwent general anaesthesia during surgery. Surprisingly, 30% of these articles did not provide any detail on anaesthetic management, while 37% reported using inhalant, hypnotic or sedative drugs only, without mention of analgesics. Pain monitoring was not reported in 87% of manuscripts. The vast majority of preclinical large animal studies on cartilage repair did not meet veterinary clinical standards for anaesthesia and analgesia, and failed to report according to the ARRIVE international guidelines. In light of serious welfare, ethical and translational validity concerns, improvement is urgently needed

Postoperative pain management in non-traumatic emergency general surgery : WSES-GAIS-SIAARTI-AAST guidelines

Background Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. Material and methods An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. Conclusion Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies.Peer reviewe

Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines

Background Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. Material and methods An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. Conclusion Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies

A Meta-Analysis of Thyroid-Related Traits Reveals Novel Loci and Gender-Specific Differences in the Regulation of Thyroid Function

Peer reviewe

Surgical osteochondral defect repair in the horse—a matter of form or function?

Focal cartilaginous and osteochondral lesions can have traumatic or chondropathic degenerative origin. The fibrocartilaginous repair tissue that forms naturally, eventually undergoes fibrillation and degeneration leading to further disruption of joint homeostasis. Both types of lesion will therefore eventually lead to activity‐related pain, swelling and decreased mobility and will frequently progress to osteoarthritis. Most attempts at realising cartilage regeneration have so far resulted in cartilage repair (and not regeneration). The aim of this article was to review experimental research on surgical cartilage restoration techniques performed so far in equine models. Currently available surgical options for treatment of osteochondral lesions in the horse are summarised. The experimental validity of equine experimental models is addressed and finally possible avenues for further research are discussed

Surgical osteochondral defect repair in the horse—a matter of form or function?

Focal cartilaginous and osteochondral lesions can have traumatic or chondropathic degenerative origin. The fibrocartilaginous repair tissue that forms naturally, eventually undergoes fibrillation and degeneration leading to further disruption of joint homeostasis. Both types of lesion will therefore eventually lead to activity‐related pain, swelling and decreased mobility and will frequently progress to osteoarthritis. Most attempts at realising cartilage regeneration have so far resulted in cartilage repair (and not regeneration). The aim of this article was to review experimental research on surgical cartilage restoration techniques performed so far in equine models. Currently available surgical options for treatment of osteochondral lesions in the horse are summarised. The experimental validity of equine experimental models is addressed and finally possible avenues for further research are discussed

Reporting of anaesthesia and pain management in preclinical large animal models of articular cartilage repair - A long way to go

Animal models continue to be used to investigate cartilage repair strategies. Adequate anaesthesia and pain management are essential in order to guarantee acceptable animal welfare as well as reproducible experimental results. This systematic review evaluates reporting of anaesthesia and pain management in surgical large animal models (horse, pig, dog, goat and sheep) of (osteo)chondral repair. Manuscripts published between 2015 and 2020 were included after a comprehensive search strategy. Data were evaluated using descriptive statistics and qualitative review. Out of 223 eligible studies, 220 studies contained incomplete information on anaesthetic and pain management. Pre-, intra- and post-operative analgesia were not mentioned in 68%, 94%, and 64% of manuscripts respectively. A total of 176 studies reported that animals underwent general anaesthesia during surgery. Surprisingly, 30% of these articles did not provide any detail on anaesthetic management, while 37% reported using inhalant, hypnotic or sedative drugs only, without mention of analgesics. Pain monitoring was not reported in 87% of manuscripts. The vast majority of preclinical large animal studies on cartilage repair did not meet veterinary clinical standards for anaesthesia and analgesia, and failed to report according to the ARRIVE international guidelines. In light of serious welfare, ethical and translational validity concerns, improvement is urgently needed