Determination of the acid-base status in 50 horses admitted with colic between December 1998 and May 1999.
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The purpose of the present study was to investigate the acid-base status and the concentration of organic acids in horses with colic caused by various disorders. Blood samples were collected from 50 horses with colic and from 20 controls. No intravenous fluids had been given prior to sample collection. Identified causes of colic included gastric ulceration, small intestinal volvulus, cecal intussusception, cecal rupture, colonic impaction, left dorsal colon displacement, right dorsal colon displacement, colonic volvulus, colitis, peritonitis, and uterine torsion. Thirty-seven horses recovered from treatment of colic, 8 horses were euthanized, and 5 died. Most cases were not in severe metabolic acidosis. In previous studies, most horses presented for diagnosis and treatment of colic were in metabolic acidosis and in shock. (+info)
Unenhanced spiral CT in acute ureteral colic: a replacement for excretory urography?
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OBJECTIVE: To compare the usefulness of unenhanced spiral CT (UCT) with that of excretory urography (EU) in patients with acute flank pain. MATERIALS AND METHODS: Thirty patients presenting with acute flank pain underwent both UCT and EU. Both techniques were used to determine the presence, size, and location of urinary stone, and the presence or absence of secondary signs was also evaluated. The existence of ureteral stone was confirmed by its removal or spontaneous passage during follow-up. The absence of a stone was determined on the basis of the clinical and radiological evidence. RESULTS: Twenty-one of the 30 patients had one or more ureteral stones and nine had no stone. CT depicted 22 of 23 calculi in the 21 patients with a stone, and no calculus in all nine without a stone. The sensitivity and specificity of UCT were 96% and 100%, respectively. EU disclosed 14 calculi in the 21 patients with a stone and no calculus in eight of the nine without a stone. UCT and EU demonstrated secondary signs of ureterolithiasis in 15 and 17 patients, respectively. CONCLUSION: For the evaluation of patients with acute flank pain, UCT is an excellent modality with high sensitivity and specificity. In near future it may replace EU. (+info)
How long do patients wait for elective general surgery?
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OBJECTIVE: Because data published on waiting times are largely determined from questionnaire-type surveys, which generate inconclusive opinion-based results, the objective of this study was to provide a quantitative measure of the extent and variance of waiting times among 3 elective general surgery procedures DESIGN: A prospective case study. SETTING: The Royal Alexandra Hospital, Edmonton. PATIENTS: From Feb. 1 to Mar. 15, 1999, all cases (90 patients) for each designated procedure--open or laparoscopic cholecystectomv for biliary colic or cholelithiasis, segmental resection or modified radical mastectomy for breast carcinoma and colon or rectal resection for colorectal carcinoma--were tabulated daily from the hospital elective operating lists. Data were prospectively acquired from individual surgeon offices (11 surgeons). Sixteen of the 90 patients were excluded, leaving 74 for analysis. OUTCOME MEASURES: Time in days from initial referral by the general practitioner to the surgeon (T1), time in days from the initial visit with the surgeon to operation for patients requiring no further diagnostic work-up by the surgeon (T2A), and time in days from the initial visit with the surgeon to operation for patients requiring further diagnostic work-up (T2B). RESULTS: The waiting period for patients who underwent non-cancer-related procedures (cholecystectomy) ranged from 83 to 106 days; patients with breast cancer waited an average of 24 (T1 + T2A) to 66 (T1 + T2B) days from the day of referral to the date of surgery and those with colorectal cancer waited an average of 32 (T1 + T2A) to 51 (T1 + T2B) days from the time of referral to operation (p < 0.05). CONCLUSION: This preliminary report aimed at quantitative measurement of time spent waiting for elective general surgery indicates that patients who underwent non-cancer-related procedures waited significantly longer for their surgery than patients who required procedures for cancer. (+info)
Perirectal abscess, colic, and dyschezia in a horse.
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A quarter horse gelding with intermittent colic was diagnosed with a perirectal abscess and dyschezia. Rectal ultrasonography identified a multiloculated, fluid-filled mass. A perirectal abscess was diagnosed when the mass ruptured and drained into the rectum. The abscess was treated successfully with warm soapy water enemas and trimethoprim and sulfamethoxazole. (+info)
Effect heterogeneity by a matching covariate in matched case-control studies: a method for graphs-based representation.
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The authors describe a method for assessing and characterizing effect heterogeneity related to a matching covariate in case-control studies, using an example from veterinary medicine. Data are from a case-control study conducted in Texas during 1997-1998 of 498 pairs of horses with colic and their controls. Horses were matched by veterinarian and by month of examination. The number of matched pairs of cases and controls varied by veterinarian. The authors demonstrate that there is effect heterogeneity related to this characteristic (i.e., cluster size of veterinarians) for the association of colic with certain covariates, using a moving average approach to conditional logistic regression and graphs-based methods. The method described in this report can be applied to examining effect heterogeneity (or effect modification) by any ordered categorical or continuous covariates for which cases have been matched with controls. The method described enables one to understand the pattern of variation across ordered categorical or continuous matching covariates and allows for any shape for this pattern. This method applies to effect modification when causality might be reasonably assumed. (+info)
Cecal rupture by Anoplocephala perfoliata infection in a thoroughbred horse in Seoul Race Park, South Korea.
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A 7-year-old Thoroughbred horse was admitted to the Equine Hospital, Korea Racing Association with signs of colic. Based on the size of impactions, the clinical signs, the results of abdominal paracentesis and medical treatment, the prognosis was poor. The horse died 3 hours later following hopeless discharge. At necropsy, the caecum and large colon were fully filled with fecal contents and there was a rupture (10 cm in dia) in the latero- ventral caecum. The mucosa of the ileo-caecal and caeco- colic valves appeared to the hyperemic, edematous and ulcerous. There were many tapeworms in the affected mucosa. Histopathologically, lesions included hyperaemia, a deep necrotic inflammatory lesion and ulcers in the mucosa and submucosa of ileo-caecal and caeco-colic valves. One hundred thirty four faecal samples were obtained from 16 stables and submitted to parasitic examination. A total of 4 genera of eggs were recovered: Stongylus spp (82.1%), Anoplocephala perfoliata (10.5%), Bovicola equi (0.7%) and Parascaris equorum (1.5%). The major findings in this study are the presence of A perfoliata and its suspected association with the colic which led into an eventual caecal rupture. This study indicates the needs for an epidemiological survey of colic that is associated with Anoplocephala. (+info)
Risk factors associated with colic in horses.
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Many factors have been identified as risk factors for colic in horses in several epidemiological studies. The aim of our paper was to review the results of 12 epidemiological studies, in order to assess the impact of each risk factor for colic. According to the literature, the factors that increase the risk of colic are feeding practices (type and quality of food, type and changes of feeding), the intrinsic factors of horses (sex, age and breed), management (type and changes of housing and activity), medical history (a previous colic, administration of a medical treatment) and parasite control (the presence of worms and type of deworming program). Several individual factors were incriminated as risk factors by all the studies. Nevertheless, the different studies did not always agree on the role of other risk factors. The conclusions were tightly related to several criteria in the selection of the study population, like the type of the epidemiological study, the number and the origin of horses included and the location of the study. (+info)
Diagnostic decision rule for support in clinical assessment of the need for surgical intervention in horses with acute abdominal pain.
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A prospective survey of horses with colic referred to a university hospital was undertaken to elaborate on a simple clinical decision support system capable of predicting whether or not horses require surgical intervention. Cases were classified as requiring surgical intervention or not on the basis of intraoperative findings or necropsy reports. Logistic regression analysis was applied to identify predictors with the strongest association with treatment needed. The classification and regression tree (CART) methodology was used to combine the variables in a simple classification system. The performance of the elaborated algorithms, as diagnostic instruments, was recorded as test sensitivity and specificity. The CART method generated 5 different classification trees with a similar basic structure consisting of: degree of pain, peritoneal fluid colour, and rectal temperature. The tree, constructed at a prevalence of 15% surgical cases, appeared to be the best proposal made by CART. In this classification tree, further discrimination of cases was obtained by including the findings of rectal examination and packed cell volume. When regarded as a test system, the sensitivity and specificity was 52% and 95%, respectively, corresponding to positive and negative predictive values of 68% and 91%. The variables examined in the present study did not provide a safe clinical decision rule. The classification tree constructed at 15% surgical cases was considered feasible, the proportion of horses incorrectly predicted to be without need of immediate surgery (false negatives) was small, whereas the proportion of horses incorrectly predicted to be in need of immediate surgery (false positives) was large. Some of the false positive horses were amenable to surgical treatment, although these cases did not conform to the strict definition of a surgical case. A less rigorous definition of a surgical case than that used in the present study would lower the percentage of false positives. (+info)