Nuclear bone scintigraphy was used to diagnose sacroiliac injury in 12 horses presented for nonsp... more Nuclear bone scintigraphy was used to diagnose sacroiliac injury in 12 horses presented for nonspecific rear limb lameness. The most common history was decreased performance and/or a mild chronic rear limb lameness which could not be localised by routine lameness examination. The scintigraphic patterns of the 12 affected horses were compared to 5 normal horses and 10 horses with lameness not related to the pelvic region. Subjective and quantitative evaluation of the bone scans clearly separated the 12 affected horses from the 5 normal horses and the 10 horses with lameness from causes other than the sacroiliac joint disease. The 12 affected horses had a scintigraphic pattern of moderate to marked increased uptake of the radiopharmaceutical within the sacroiliac joint region on the side of lameness. In contrast, the 5 normal horses and 10 horses scanned for other causes of lameness, had a symmetric, or only slightly asymmetric pattern of radioisotope uptake. Although nonspecific for the type of injury, nuclear bone scintigraphy is considered sensitive for the detection of sacroiliac injuries in horses.
Javma-journal of The American Veterinary Medical Association, Dec 15, 2011
Objective—To describe clinical and physiologic changes during lift laparoscopy in dogs and cats a... more Objective—To describe clinical and physiologic changes during lift laparoscopy in dogs and cats and determine immediate surgical outcome. Design—Retrospective case series. Animals—Client-owned dogs (n = 7) and cats (5). Procedures—A custom-made lift device was used to retract the abdominal wall for laparoscopic instrumentation. The lift device was used first in 3 dog cadavers to assess the risk of complications. Thereafter, the device was used for routine laparoscopic procedures in client-owned animals. Data collected from medical records included signalment, body weight, clinical signs, diagnosis, surgery type and duration, conversion from laparoscopic to open surgery, preoperative American Society of Anesthesiologists score, mean intraoperative respiratory rate, mean and peak end-tidal partial pressure of CO2 during the laparoscopic surgery, ventilation method, mean saturation of hemoglobin with O2, mean and systolic arterial pressures during the laparoscopic surgery, total anesthesia time, signs of pain immediately after recovery, duration of hospitalization, and postoperative complications. Results—Lift laparoscopy was successfully performed in 10 of the 12 patients. No adverse effects were noted with the use of this technique. However, in 1 dog and 1 cat, conversion to laparotomy was necessary because of poor visualization. Conclusions and Clinical Relevance—Results suggested that lift laparoscopy is feasible in dogs and cats and is an option that can be used in clinical practice, especially if creation of positive-pressure pneumoperitoneum is not desirable.
Objective: This report evaluates the use of 4.5- and 5.5-mm cannulated drill bits for articular c... more Objective: This report evaluates the use of 4.5- and 5.5-mm cannulated drill bits for articular cartilage removal from the proximal interphalangeal joints of equine cadaver limbs. Animals: Limbs from 8 equine cadavers, all with normal proximal interphalangeal joints. Procedure: Proximal interphalangeal joints of 32 limbs from 8 equine cadavers were drilled using either 4.5- or 5.5-mm cannulated drill bits. Pastern joints were then disarticulated, and intra-articular drilling was evaluated by visual inspection. Results: Post-drilling evaluation revealed complete intra-articular drilling occurred in all 32 joints. Conclusion: Canulated 4.5- and 5.5-mm drill bits resulted in consistent accurate intra-articular drilling in the proximal interphalangeal joint of horses. Clinical relevance: Cannulated drill bits provided an effective and consistent modality for articular cartilage removal with potential for improved accuracy of articular drilling and applications in minimally invasive proximal interphalangeal joint arthrodesis.
Objectives: To develop methods to isolate, culture, and characterize equine hoof endothelial cell... more Objectives: To develop methods to isolate, culture, and characterize equine hoof endothelial cells (EC) and keratinocytes. Sample population: Cells harvested from the forelimbs of 8 horses. Procedure: EC were obtained via catheters placed in the palmar digital arteries of the disarticulated lower portion of the forelimbs from 4 horses that had been heparinized prior to euthanasia. Phosphate-buffered saline solution was used to remove and discard RBC from blood vessels, and collagenase was used to loosen and flush EC from the vasculature. Hoof keratinocytes were obtained from 4 recently euthanatized horses by use of dispase/trypsin dissociation of the coronary band epidermis. Use of an extracellular matrix gel as a culture flask attachment factor was important to the success of hoof keratinocyte cultures. Results: EC from the palmar digital arteries were successfully cultured and characterized by in vitro morphology, uptake of a fluorescence-labeled acetylated-low density lipoprotein, and lack of expression of von Willebrand factor and smooth muscle actin. Hoof keratinocytes were characterized by morphology in culture and expression of keratin proteins, as determined by immunochemical reaction. Keratinocyte cultures were also positive for vimentin expression. Conclusions: Culture techniques to isolate and characterize hoof cells should aid investigators in their study of equine hoof pathobiologic features, especially as it relates to laminitis.
In 4 adult horses, simple, nondisplaced, incomplete fracture of the proximal extremity of the thi... more In 4 adult horses, simple, nondisplaced, incomplete fracture of the proximal extremity of the third metacarpal bone (MC3) was identified radiographically only on the dorsopalmar projection. Lameness was slight to moderate. Although nerve blocks of the foot and fetlock did not alter the lameness, high palmar regional nerve block improved the gait in 1 of the 2 horses on which it was performed. Pain on palpation or swollen distal accessory (inferior check) ligament, flexor tendons, and suspensory ligament were not found in any horse. The fracture was localized to the palmar surface of the proximal extremity of the MC3 on the basis of the intense uptake of radiopharmaceutical (99MTc-labeled sodium medronate) observed in that area during the soft tissue and delayed bone phases of a nuclear scintigraphic examination (nuclear scan) performed concurrently with radiography. Of 4 horses evaluated 6 months after the initial diagnosis, 3 had medullary sclerosis without radiographic evidence of fracture; results of follow-up nuclear scintigraphy performed in one of these horses at the same time were normal. Incomplete fracture also was suspected in another 6 adult horses with clinical lameness referable to the proximal extremity of the MC3. Although a fracture line could not be seen radiographically, trabecular hypertrophy and/or medullary sclerosis of the proximal extremity of the MC3 were detected on the dorsopalmar projection. Further, during nuclear scintigraphy, an intense uptake of the radiopharmaceutical was observed on the palmar aspect of the proximal extremity of the MC3 in all 6 horses.(ABSTRACT TRUNCATED AT 250 WORDS)
Summary Post anaesthetic myelopathy is a rare but devastating complication of equine anaesthesia ... more Summary Post anaesthetic myelopathy is a rare but devastating complication of equine anaesthesia and there is a need for better understanding of the condition and to raise veterinary awareness. The aim of this study was to collect data on unreported cases and combine those with reported cases to better identify possible risk factors and early clinical signs and outcomes of horses developing post anaesthetic myelopathy (PAM). A survey was conducted to identify cases of equine PAM. Records were also requested via the American College of Veterinary Anaesthesiologists listserve. Additional cases of PAM were located through review of the literature. Eighteen new cases and 12 published cases were identified. Large-framed breeds between 6–24 months of age were more commonly affected (23/30). The majority of horses were positioned in dorsal recumbency during anaesthesia. Lack of movement and deep pain of the rear limbs, loss of anal tone and lack of panniculus response from the mid to caudal thorax distally were the most common clinical findings. Reported treatments resulted in no improvement of clinical signs and all horses died or were subjected to euthanasia from a few hours to 8 days post operatively. Poliomyelomalacia of the caudal spinal cord is the most common histopathological finding. Although a rare complication it is a catastrophic risk that can be eliminated by performing a standing operation. Hopefully in the future better understanding of this condition will lead to prevention and treatment strategies.
Javma-journal of The American Veterinary Medical Association, Feb 1, 2004
Objective—To assess the use of magnetic resonance (MR) imaging for identifying subchondral bone d... more Objective—To assess the use of magnetic resonance (MR) imaging for identifying subchondral bone damage in the distal limbs of horses. Design—Retrospective study. Animals—11 horses. Procedure—Medical records of horses with lameness and subsequent evidence of subchondral bone damage as determined by MR imaging were reviewed. Severity and duration of lameness, results of diagnostic local anesthesia and diagnostic testing, surgical and necropsy findings, and treatment were recorded. Outcome was determined by follow-up information obtained from the owner or referring veterinarian. Results—Lameness was localized by physical examination and diagnostic local anesthesia. Lameness was localized to the metacarpophalangeal or metatarsophalangeal joint in 4 horses, distal interphalangeal joint in 5 horses, and tarsocrural joint in 2 horses. The duration of lameness ranged from 2 weeks to 20 months. Magnetic resonance imaging of the affected joints revealed abnormal fluid accumulation within the subchondral bone. None of the abnormalities observed by MR imaging were detected by radiography. Subchondral bone damage was diagnosed in all horses. Arthroscopy of the affected joint was performed in 4 horses. Communication with the articular surface of the affected bone was suspected on the basis of results of MR imaging in 4 horses and was confirmed by arthroscopy in 1 horse and by necropsy in 1 horse. Conclusions and Clinical Relevance—Magnetic resonance imaging was useful for providing a diagnosis when other imaging techniques did not definitively identify the cause of lameness. Subchondral bone damage was clearly identified by MR imaging and should be considered as a cause of lameness in horses in which radiographic findings are unremarkable. ( J Am Vet Med Assoc 2004;224:411–418)
Javma-journal of The American Veterinary Medical Association, Jul 15, 2009
Case Description—A 2-year-old Quarter Horse was evaluated because of a progressive left-sided fac... more Case Description—A 2-year-old Quarter Horse was evaluated because of a progressive left-sided facial deformity and unilateral nasal and ocular discharge. Clinical Findings—Physical examination revealed convexity of the left frontonasal region, left-sided nasal and ocular discharge, and decreased air flow through the left nares. Radiography and computed tomography revealed an extensively mineralized mass occupying most of the left paranasal sinuses. Treatment and Outcome—The mass was surgically debulked, but complete removal was precluded because the mass was tightly adhered to the frontal and maxillary bones. Results of histologic examination of the mass were consistent with a diagnosis of osteoma. The horse developed transient pyrexia and colic following surgery, and postoperative radiography revealed gas opacities in the lateral ventricles of the brain, consistent with iatrogenic pneumocephalus. However, the horse did not develop any neurologic signs and was performing normally 2 years after surgery. Clinical Relevance—Findings reinforce concerns that paranasal sinus surgery in horses can be associated with intracranial complications such as pneumocephalus. In horses with a mass involving the paranasal sinuses, computed tomography may be helpful in determining the boundaries of the mass and formulating a surgical treatment plan.
Nuclear bone scintigraphy was used to diagnose sacroiliac injury in 12 horses presented for nonsp... more Nuclear bone scintigraphy was used to diagnose sacroiliac injury in 12 horses presented for nonspecific rear limb lameness. The most common history was decreased performance and/or a mild chronic rear limb lameness which could not be localised by routine lameness examination. The scintigraphic patterns of the 12 affected horses were compared to 5 normal horses and 10 horses with lameness not related to the pelvic region. Subjective and quantitative evaluation of the bone scans clearly separated the 12 affected horses from the 5 normal horses and the 10 horses with lameness from causes other than the sacroiliac joint disease. The 12 affected horses had a scintigraphic pattern of moderate to marked increased uptake of the radiopharmaceutical within the sacroiliac joint region on the side of lameness. In contrast, the 5 normal horses and 10 horses scanned for other causes of lameness, had a symmetric, or only slightly asymmetric pattern of radioisotope uptake. Although nonspecific for the type of injury, nuclear bone scintigraphy is considered sensitive for the detection of sacroiliac injuries in horses.
Javma-journal of The American Veterinary Medical Association, Dec 15, 2011
Objective—To describe clinical and physiologic changes during lift laparoscopy in dogs and cats a... more Objective—To describe clinical and physiologic changes during lift laparoscopy in dogs and cats and determine immediate surgical outcome. Design—Retrospective case series. Animals—Client-owned dogs (n = 7) and cats (5). Procedures—A custom-made lift device was used to retract the abdominal wall for laparoscopic instrumentation. The lift device was used first in 3 dog cadavers to assess the risk of complications. Thereafter, the device was used for routine laparoscopic procedures in client-owned animals. Data collected from medical records included signalment, body weight, clinical signs, diagnosis, surgery type and duration, conversion from laparoscopic to open surgery, preoperative American Society of Anesthesiologists score, mean intraoperative respiratory rate, mean and peak end-tidal partial pressure of CO2 during the laparoscopic surgery, ventilation method, mean saturation of hemoglobin with O2, mean and systolic arterial pressures during the laparoscopic surgery, total anesthesia time, signs of pain immediately after recovery, duration of hospitalization, and postoperative complications. Results—Lift laparoscopy was successfully performed in 10 of the 12 patients. No adverse effects were noted with the use of this technique. However, in 1 dog and 1 cat, conversion to laparotomy was necessary because of poor visualization. Conclusions and Clinical Relevance—Results suggested that lift laparoscopy is feasible in dogs and cats and is an option that can be used in clinical practice, especially if creation of positive-pressure pneumoperitoneum is not desirable.
Objective: This report evaluates the use of 4.5- and 5.5-mm cannulated drill bits for articular c... more Objective: This report evaluates the use of 4.5- and 5.5-mm cannulated drill bits for articular cartilage removal from the proximal interphalangeal joints of equine cadaver limbs. Animals: Limbs from 8 equine cadavers, all with normal proximal interphalangeal joints. Procedure: Proximal interphalangeal joints of 32 limbs from 8 equine cadavers were drilled using either 4.5- or 5.5-mm cannulated drill bits. Pastern joints were then disarticulated, and intra-articular drilling was evaluated by visual inspection. Results: Post-drilling evaluation revealed complete intra-articular drilling occurred in all 32 joints. Conclusion: Canulated 4.5- and 5.5-mm drill bits resulted in consistent accurate intra-articular drilling in the proximal interphalangeal joint of horses. Clinical relevance: Cannulated drill bits provided an effective and consistent modality for articular cartilage removal with potential for improved accuracy of articular drilling and applications in minimally invasive proximal interphalangeal joint arthrodesis.
Objectives: To develop methods to isolate, culture, and characterize equine hoof endothelial cell... more Objectives: To develop methods to isolate, culture, and characterize equine hoof endothelial cells (EC) and keratinocytes. Sample population: Cells harvested from the forelimbs of 8 horses. Procedure: EC were obtained via catheters placed in the palmar digital arteries of the disarticulated lower portion of the forelimbs from 4 horses that had been heparinized prior to euthanasia. Phosphate-buffered saline solution was used to remove and discard RBC from blood vessels, and collagenase was used to loosen and flush EC from the vasculature. Hoof keratinocytes were obtained from 4 recently euthanatized horses by use of dispase/trypsin dissociation of the coronary band epidermis. Use of an extracellular matrix gel as a culture flask attachment factor was important to the success of hoof keratinocyte cultures. Results: EC from the palmar digital arteries were successfully cultured and characterized by in vitro morphology, uptake of a fluorescence-labeled acetylated-low density lipoprotein, and lack of expression of von Willebrand factor and smooth muscle actin. Hoof keratinocytes were characterized by morphology in culture and expression of keratin proteins, as determined by immunochemical reaction. Keratinocyte cultures were also positive for vimentin expression. Conclusions: Culture techniques to isolate and characterize hoof cells should aid investigators in their study of equine hoof pathobiologic features, especially as it relates to laminitis.
In 4 adult horses, simple, nondisplaced, incomplete fracture of the proximal extremity of the thi... more In 4 adult horses, simple, nondisplaced, incomplete fracture of the proximal extremity of the third metacarpal bone (MC3) was identified radiographically only on the dorsopalmar projection. Lameness was slight to moderate. Although nerve blocks of the foot and fetlock did not alter the lameness, high palmar regional nerve block improved the gait in 1 of the 2 horses on which it was performed. Pain on palpation or swollen distal accessory (inferior check) ligament, flexor tendons, and suspensory ligament were not found in any horse. The fracture was localized to the palmar surface of the proximal extremity of the MC3 on the basis of the intense uptake of radiopharmaceutical (99MTc-labeled sodium medronate) observed in that area during the soft tissue and delayed bone phases of a nuclear scintigraphic examination (nuclear scan) performed concurrently with radiography. Of 4 horses evaluated 6 months after the initial diagnosis, 3 had medullary sclerosis without radiographic evidence of fracture; results of follow-up nuclear scintigraphy performed in one of these horses at the same time were normal. Incomplete fracture also was suspected in another 6 adult horses with clinical lameness referable to the proximal extremity of the MC3. Although a fracture line could not be seen radiographically, trabecular hypertrophy and/or medullary sclerosis of the proximal extremity of the MC3 were detected on the dorsopalmar projection. Further, during nuclear scintigraphy, an intense uptake of the radiopharmaceutical was observed on the palmar aspect of the proximal extremity of the MC3 in all 6 horses.(ABSTRACT TRUNCATED AT 250 WORDS)
Summary Post anaesthetic myelopathy is a rare but devastating complication of equine anaesthesia ... more Summary Post anaesthetic myelopathy is a rare but devastating complication of equine anaesthesia and there is a need for better understanding of the condition and to raise veterinary awareness. The aim of this study was to collect data on unreported cases and combine those with reported cases to better identify possible risk factors and early clinical signs and outcomes of horses developing post anaesthetic myelopathy (PAM). A survey was conducted to identify cases of equine PAM. Records were also requested via the American College of Veterinary Anaesthesiologists listserve. Additional cases of PAM were located through review of the literature. Eighteen new cases and 12 published cases were identified. Large-framed breeds between 6–24 months of age were more commonly affected (23/30). The majority of horses were positioned in dorsal recumbency during anaesthesia. Lack of movement and deep pain of the rear limbs, loss of anal tone and lack of panniculus response from the mid to caudal thorax distally were the most common clinical findings. Reported treatments resulted in no improvement of clinical signs and all horses died or were subjected to euthanasia from a few hours to 8 days post operatively. Poliomyelomalacia of the caudal spinal cord is the most common histopathological finding. Although a rare complication it is a catastrophic risk that can be eliminated by performing a standing operation. Hopefully in the future better understanding of this condition will lead to prevention and treatment strategies.
Javma-journal of The American Veterinary Medical Association, Feb 1, 2004
Objective—To assess the use of magnetic resonance (MR) imaging for identifying subchondral bone d... more Objective—To assess the use of magnetic resonance (MR) imaging for identifying subchondral bone damage in the distal limbs of horses. Design—Retrospective study. Animals—11 horses. Procedure—Medical records of horses with lameness and subsequent evidence of subchondral bone damage as determined by MR imaging were reviewed. Severity and duration of lameness, results of diagnostic local anesthesia and diagnostic testing, surgical and necropsy findings, and treatment were recorded. Outcome was determined by follow-up information obtained from the owner or referring veterinarian. Results—Lameness was localized by physical examination and diagnostic local anesthesia. Lameness was localized to the metacarpophalangeal or metatarsophalangeal joint in 4 horses, distal interphalangeal joint in 5 horses, and tarsocrural joint in 2 horses. The duration of lameness ranged from 2 weeks to 20 months. Magnetic resonance imaging of the affected joints revealed abnormal fluid accumulation within the subchondral bone. None of the abnormalities observed by MR imaging were detected by radiography. Subchondral bone damage was diagnosed in all horses. Arthroscopy of the affected joint was performed in 4 horses. Communication with the articular surface of the affected bone was suspected on the basis of results of MR imaging in 4 horses and was confirmed by arthroscopy in 1 horse and by necropsy in 1 horse. Conclusions and Clinical Relevance—Magnetic resonance imaging was useful for providing a diagnosis when other imaging techniques did not definitively identify the cause of lameness. Subchondral bone damage was clearly identified by MR imaging and should be considered as a cause of lameness in horses in which radiographic findings are unremarkable. ( J Am Vet Med Assoc 2004;224:411–418)
Javma-journal of The American Veterinary Medical Association, Jul 15, 2009
Case Description—A 2-year-old Quarter Horse was evaluated because of a progressive left-sided fac... more Case Description—A 2-year-old Quarter Horse was evaluated because of a progressive left-sided facial deformity and unilateral nasal and ocular discharge. Clinical Findings—Physical examination revealed convexity of the left frontonasal region, left-sided nasal and ocular discharge, and decreased air flow through the left nares. Radiography and computed tomography revealed an extensively mineralized mass occupying most of the left paranasal sinuses. Treatment and Outcome—The mass was surgically debulked, but complete removal was precluded because the mass was tightly adhered to the frontal and maxillary bones. Results of histologic examination of the mass were consistent with a diagnosis of osteoma. The horse developed transient pyrexia and colic following surgery, and postoperative radiography revealed gas opacities in the lateral ventricles of the brain, consistent with iatrogenic pneumocephalus. However, the horse did not develop any neurologic signs and was performing normally 2 years after surgery. Clinical Relevance—Findings reinforce concerns that paranasal sinus surgery in horses can be associated with intracranial complications such as pneumocephalus. In horses with a mass involving the paranasal sinuses, computed tomography may be helpful in determining the boundaries of the mass and formulating a surgical treatment plan.
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Papers by Claude Ragle