Peribulbar block in equine isolated heads : development of a single needle technique and tomographic evaluation

Peribulbar block (PPB) has been used in humans as a safer alternative to retrobulbar block (RBB). PBB, depends on the diffusion of anaesthetic solution into the muscle across the connective tissue and it is performed introducing the needle within the extraconal space. The advantages are fewer complications and palpebral akinesia. In Veterinary Medicine few studies describe this technique in dogs and cats (Shilo- Benjamini et al., 2013). The aim of the study is to determinate, in equine specimens, feasibility of inferior PBB with single needle injection, by using contrast medium (CM), and to evaluate thought Computed Tomography (CT) the distribution of the injected volume and regional anaesthesia likelihood. PBB was performed in 10 orbits. The mixture injected consisted of 20 ml of physiological solution and iodinated CM at 25%. Each periorbital area underwent three CT scans. A basal acquisition to assess the needle position before the injection, a second and third scan were performed immediately after injection, and after application of pressure on the periorbital surface area to promote CM diffusion. The injectate distribution at the base and within the extraocular muscle cone (EOMC) and around the optic nerve was evaluated and scored based on Shilo-Benjamini\u2019s work of 2017. The mean minimum distance between the tip of the needle and the optic was 2,23 mm \ub10,2. The mean volume distribution before pressure application was 23.56 cm3 \ub1 2.58 and after pressure application was 27.56 cm3 \ub1 4.8. The CM median distribution around the optic nerve at the base of the EOMC was of 117\ub0 prior pressure and 189\ub0 after pressure. The CM distribution within the EOMC was present in 1 orbit prior pressure and in 3 orbits after pressure. The CM distribution at the base of EOMC was considered unlikely to provide regional anaesthesia in 2 orbits, possible in 3 orbits and likely in 5. In the present study, intraconal distribution was not consistent. For this reason, the likelihood of achieving regional anaesthesia was evaluated at the EOMC base where through the optic foramen the oculomotor, trochlear nerve, ophthalmic branch of the trigeminal nerve, and the abducens travel to reach the orbit together with the optic nerve. Whereas the maxillary branch of the trigeminal nerve passes through the foramen rotundum (Carastro 2004). Therefore, despite the lack of intraconal distribution if the EOMC base had good distribution then it was considered likely to provide regional anaesthesia. This approach needs to be evaluated in clinical trials to assess its feasibility and effectiveness in locoregional anaesthesia; moreover, further investigations on equine PBB are mandatory with higher volumes of injectate and different approaches

Continuous rate infusion of dexmedetomidine vs subcutaneous administration in anaesthetized horses undergoing MRI examination

Up to 2005, dexmedetomidine use had not been reported in equine. Since then, several experimental and clinical studies have been published. The main reason for this increase relies on its beneficial pharmacological profile, including short half-life and rapid redistribution (1). The aim of the study is to compare the clinical effects and recovery quality after continuous rate infusion (CRI) or subcutaneous administration of dexmedetomidine in horses undergoing general anaesthesia. Fourteen horses scheduled for MRI examination were included. All horses were sedated with acepromazine 0.03 mg kg-1 intravenously (IV) and detomidine 10 \ub5g kg-1 (IV). Anaesthesia was induced with ketamine 3 mg kg-1 (IV) and diazepam 0.04 mg kg-1 (IV) and maintained with isofluorane in 60% oxygen; end-tidal isoflurane concentration was maintained between 1.3-1.4 %. Horses were randomly divided in two groups. Group \u201cDex CRI\u201d received dexmedetomidine intravenously at 1 \ub5g kg-1 hour-1, group \u201cDex SC\u201d received 2 \ub5g kg-1 of dexmedetomidine subcutaneously every 60 minutes. If nystagmus or incessant fighting against ventilator occurred, ketamine rescue at 0.1 mg kg-1 was given. In case of sudden movements, thiopental 0.5-1.0 mg kg-1 IV was given. Ringer\u2019s lactate was given at 3 mL kg-1 hour-1, dobutamine was administered IV and the rate adjusted to maintain MAP>70 mmHg. Controlled mechanical ventilation using intermittent positive pressure ventilation was adjusted to maintain arterial carbon dioxide partial pressure between 38-45 mmHg. Heart rate, invasive arterial blood pressure, arterial blood gases, total dose of dobutamine administered, ketamine rescue needed, urine production were recorded. Time required until extubation and time to attain sternal and standing position were noted. The main anaesthesiologist assessed recovery quality graded on a standard scoring 5-point scale with a score of 1 representing the best recovery (2). Mann-Whitney U test was applied for non-parametric data and T-test for parametric data (p 640.05). There was no statistically differences in physiological intra-anaesthetic parameters, in body weight (kg) (CRI 521\ub153; SC 506\ub176), age (years) (CRI 10.7\ub12.1; SC 10.8\ub14.1), anaesthesia duration (min) (CRI 139\ub19.,7; SC 144\ub116.2), number of ketamine rescue needed (CRI 1\ub11.15; SC 0.5\ub11.13), recovery score (CRI 1.8\ub11,2; SC 1.5\ub10,5). Also time until extubation (min) (CRI 11.5\ub15.0; SC 9.7\ub12.6), time to attain sternal (min) (CRI 41.5\ub112.2; SC 49.7\ub16.0) and standing position (min) (CRI 50.7\ub114.6; SC 57.2\ub16.,0) were not statistically different. There was statistical significance in urine production (L) (CRI 8.0\ub13.5; SC 11.1\ub14.4) and total dobutamine mcg/kg/min (CRI 0.89\ub10.35; SC 0.56\ub10.18). Subcutaneous administration of dexmedetomidine has product similar clinical effects to those achieved with CRI. It has permitted a significative reduction in dobutamine administration and a more stable depth of anaesthesia confirmed by the lower number of rescue ketamine boluses required even if not statistically different. Further studies are required to evaluate different dosages both in CRI and subcutaneous administration

Life history differences across a latitudinal gradient in side-blotched lizards (Uta stansburiana)

Latitudinal variation has long been known to affect life history. Bergmann and Allen made latitudinal “rules” for mammalian anatomy and Lack, Skutch, and Moreau described differences in life history in birds. Trade-offs occur between important life history processes, like self maintenance (immunity) and other expensive but necessary processes. It is likely that trade-offs occur mostly when resources are limited. Side-blotched lizards have a wide geographic range, and more northerly lizards have been observed to have longer lifespans than their southern conspecifics. We hypothesized that northern sideblotched lizards would invest more energy into self-maintenance compared to shorter-lived southern animals

The basis for ductility evaluation in SFRC structures in MC2020: An investigation on slabs and shallow beams

The paper presents a synthesis of an extensive experimental campaign on linear and two-dimensional steel fiber reinforced concrete (SFRC) structural elements carried out to check the ductility requirements aimed at guaranteeing limit analysis approaches for the computation of ultimate load-bearing capacity of SFRC structures; special attention is devoted to the role of the degree of redundancy of the structure. In particular, full-scale shallow beams and slabs reinforced with steel fibers (with or without conventional longitudinal reinforcement) were tested in two different laboratories: the Politecnico di Milano (PoliMI) and the University of Brescia (UniBS). In this experimental campaign, two different fiber contents and fiber types were considered. The experimental investigation, carried out within the activities to support Annex L of Eurocode 2, was fundamental also for developing the design rules included in the fib Model Code 2020 and allowed to formulate conclusions regarding optimization of the mix design, ductility, and design prediction at the ultimate capacity

Spleen hematoma in a ferret: imaging and surgical findings

Spleen hematoma is not an uncommon pathology in the ferret, nevertheless it has been poorly described in literature. A 5,5 years old male neutered ferret was referred for anorexia and gastrointestinal disorders. Physical examination revealed a no painful moderate abdominal distension. Radiographic examination of the abdomen revealed a mass of 20mm in diameter in the spleen. A complete blood analysis was carried out and revealed a mild leukocytosis. The mass was further investigated by ultrasonography (US) that confirmed the presence of an hypoechoic rounded lesion within the splenic parenchyma. Differential diagnoses included spleen hematomas, coronavirus infection, lymphoma or lymphosarcoma. The size and morphology of the mass and the blood values has been monitored frequently by ultrasound and no fine needle aspiration was performed in order to avoid bleeding. To better characterize the lesion a multidetector Computed Tomography (CT) pre and post-contrast examination of the chest and abdomen was performed and revealed a huge intraparenchymal hypoattenuating mass in the apex of the spleen (35 mm in diameter), showing a mild enhancement on post-contrast sequences. Because of US and CT finding was suggestive of a benign infiltrative pathology, a splenectomy was recommended. Five days later the patient was admitted to surgery in emergency because the mass was lacerated spontaneously. The histologic examination of the mass confirmed a spleen hematoma. Spleen hematoma should be considered as a differential diagnosis in case of or nodular lesions or splenomegaly in the ferret

Teg® and rotem® traces: Clinical applications of viscoelastic coagulation monitoring in neonatal intensive care unit

The concentration of the majority of hemostatic proteins differs considerably in early life, especially in neonates compared to adulthood. Knowledge of the concept of developmental hemostasis is an essential prerequisite for the proper interpretation of conventional coagulation tests (CCT) and is critical to ensure the optimal diagnosis and treatment of hemorrhagic and thrombotic diseases in neonatal age. Viscoelastic tests (VETs) provide a point-of-care, real-time, global, and dynamic assessment of the mechanical properties of the coagulation system with the examination of both cellular and plasma protein contributions to the initiation, formation, and lysis of clots. In this work, we provide a narrative review of the basic principles of VETs and summarize current evidence regarding the two most studied point-of-care VETs, thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®), in the field of neonatal care. A literature analysis shows that viscoelastic hemostatic monitoring appears to be a useful additive technique to CCT, allowing targeted therapy to be delivered quickly. These tools may allow researchers to determine the neonatal coagulation profile and detect neonatal patients at risk for postoperative bleeding, coagulation abnormalities in neonatal sepsis, and other bleeding events in a timely manner, guiding transfusion therapies using the goal-oriented transfusion algorithm. However, diagnosis and treatment algorithms incorporating VETs for neonatal patients in a variety of clinical situations should be developed and applied to improve clinical outcomes. Further studies should be performed to make routinary diagnostic and therapeutic application possible for the neonatal population

Injuries at the articular surface of the proximal phalanx and third metacarpal/metatarsal bone in horses, detected with low-field magnetic resonance imaging: 13 case (2010-2017)

Introduction Injuries to the fetlock region are common in horses used for athletic purposes and Magnetic Resonance Imaging (MRI) is diffusely used to diagnose bone injuries (1-3). Despite the classification used in human medicine (4), in the equine practice the terms \u201cshort incomplete fracture\u201d, \u201cstress fractures\u201d, \u201cfissure, transchondral fracture\u201d and \u201costeochondral fracture\u201d are often used interchangeably. The purpose of the study was to report the case details, diagnostic imaging findings and outcomes in sport horses with a diagnosis of traumatic injuries at the articular surfaces of metacarpophalangeal and metatarsophalangeal joint (MCPJ/MTPJ) and verify if it is possibile to differentiate between subchondral, chondral and osteochondral fracture using a low-field MRI under general anesthesia. Material and methods Magnetic Resonance examination of horses referred for lameness localised to the fetlock region over a 7-year period were reviewed. Horses were selected for inclusion in the study that had MRI findings suggestive of primary bone lesion involving the articular surface of third metacarpal/metatarsal bone (MCIII/MTIII) or proximal phalanx (P1). Signalment, detailed clinical history, athletic use, MRI findings and follow-up informations were recorded. On the basis of MRI patterns, injuries at the articular surface were classified as osteochondral fractures (OF), chondral fractures (CF), or subchondral fractures (SF) (4). Lesions were identified as an OF when defect of cartilaginous lining and/or signal change of the cartilage layer was observed in association with subchondral bone marrow lesion and arcuate or linear irregular signal change in the subchondral bone. In the SF there was no involvement of the cartilaginous lining, while in the CF there is a displaced fragment and no alteration of the subchondral black line. Results Thirteen horses have been included in the study; five horses were used for show jumping, four for flat race, two for monta vaquera and two for eventing and dressage, respectively. The median age was 8.5 years of age, with a range between 2 and 16 yo. All horses had unilateral lameness, seven horses with acute onset, while six had a chronic lameness (>12 weeks). The degree of lameness varied from grades 2/5 to 4/5. In four horses lameness was localised to the hindlimb. In four horses a subtle, radiolucent, ill-defined line was observed in the radiographic views, suggestive of short incomplete fracture. Six horses had MRI findings suggestive of OF (impacted type) involving the sagittal groove of P1 in three cases, the medial aspect of P1 in one horse and the medial condyle of MCIII/MTIII in two horses. Seven horses had SF at the medial condyle of MCIII/MTIII in three cases, at the lateral condyle of MCIII/MTIII in two cases and involving the sagittal goove of the proximal phalanx in the last two cases. No MRI findings suggestive of CF were observed in the present study. In six horses no other abnormalities were detected while in seven cases additional alterations were observed, including mild desmopathy of MCPJ/MTPJ collateral ligaments, desmopathy of the suspensory ligament branches, oblique sesamoidean ligament alteration or adhesions between deep digital flexor tendon and distal sesamoidean impar ligament. All horses were treated with a period of rest; four horses received a therapy with biphosphonates and one horse was treated with intra-articular jaluronic acid. Median time of the final follow up was 32 weeks (range: 12 to 40 weeks). Of the 13 horses included in the study, nine (69%) were sound and returned to thier previous athletic use. Three horses were still lame due to MCPJ/MTPJ pain while another one was lame due to pain localised to the suspensory ligament origin. Conclusion In equine practice, the terms osteochondral fractures, tranchondral fractures, short fracture and incomplete fracture were used interchangeably. Differentiating between osteochondral and subchondral fractures is mandatory for an accurate prognosis (4). Even if low-field MRI has a low sensitivity in detecting articular surface damage (3,5), in the present study was possible to discriminate between OF and SF in all cases. Fat-suppressed images had the capability to enhance occult bone lesions like bone marrow traumatic damage. Fat-suppressed and T1-Weighted sequences allowed to detect defect in the overlying articular surface. Despite the results reported by Gold et al. (2017) in the present study 70% of cases returned to previous athletic levels (1). Considering that all horses with a diagnosis of subchondral fracture were sound at the time of re-check while horses still lame had osteochondral fracture, we can speculate that subchondral fracture has a better prognosis. In our study all horses underwent a period of rest and none received a surgical management. Differentiating between SF and OF could help the surgeon in the treatment choice, conservative in case of subchondral injuries and surgical when cartilage involvement was detected (6,8). In the report of Smith at all. (2017), of 12 cases with a diagnosis of short incomplete fracture or osteochondral fracture, 11 returned to race after surgical repair. Even if radiographic examination can, in some cases, identify short incomplete fractures, magnetic resonance examination allows to evaluate the presence of cartilage involvement, bone marrow lesions and simultaneous soft tissue abnormalities (6). The early diagnosis of these lesions is mandatory to prevent repetiteve loading on damaged bone and possible extension to the cortex (7) that can led to catastrophic injuries In conclusion, MRI has to be considered the best imaging technique in the evaluation of an incomplete fractures, in order to differentiate between osteochondral and subchondral fractures for the elective treatment of a specific pathological entity