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Summary A 15‐year‐old Warmblood gelding was presented with recurrence of a histologically confirmed osteosarcoma of the left second and third metacarpal bones 3 years after initial diagnosis and treatment. Initially, surgical excision was performed, followed by local injection of carboplatin 11 weeks later. The horse was sound after surgery and was used for low‐level dressage and jumping. Three years later, the horse developed an acute onset of lameness in the left forelimb and a painful soft tissue swelling at the proximomedial metacarpal region. Radiographs showed a spiculated periosteal reaction on the medial aspect of the third metacarpal bone, indicating re‐activation of the lesion. Stereotactic radiation therapy was performed with a protocol consisting of three fractions under general anaesthesia (Mo‐We‐Fr schedule), and a total dose of 30 Gy. The technique used was volumetric‐modulated arc therapy guided by cone beam computed tomography for daily positioning. Following the radiation therapy, the horse became sound at walk, and 1 month later, it became sound at trot. Follow‐up by veterinary examination 18 months after final treatment revealed no lameness at walk and trot, and a stable radiographic appearance. [ABSTRACT FROM AUTHOR]

Summary: A horse with an open medial luxation of the left metatarsophalangeal joint with extensive cartilage and soft tissue damage and severe contamination of the wound was treated with a two‐stage approach. In the first stage, the lesion was cleaned, the luxation was reduced, the wound was sutured and the limb was kept in a cast for a total time of 56 days. In the second stage, an arthrodesis of the affected joint was carried out, using a 13‐hole broad 4.5 LCP plate. The limb was then kept in a cast for an additional total time of 56 days. At 70 days after the arthrodesis, the horse was brought in for a final check‐up, and only a mechanical lameness remained at that time. No significant complications occurred. Previous case reports on the treatment of metatarso‐/metacarpophalangeal luxations include neither cases as severe as the one presented here nor treatment by fetlock arthrodesis. This case illustrates that horses with a complicated, open luxation of the fetlock can be salvaged for breeding purposes. [ABSTRACT FROM AUTHOR]

Summary: Palmar digital neurectomy (PDN) is used in horses for treating chronic foot pain refractory to other treatments and is most often performed using the guillotine technique or the pull‐through technique. This study was performed to compare the outcome of the guillotine technique and the pull‐through technique for PDN. Medical records of horses undergoing PDN (January 2008–February 2017) were reviewed (guillotine technique: n = 25, pull‐through technique: n = 15). Outcome was obtained by telephone questionnaire. There was no significant difference between treatment groups for the return to athletic activity, presence of residual/recurrent lameness, occurrence of post‐operative complications and owner satisfaction. Outcome was similar for both techniques, albeit with highly variable individual responses. Establishing realistic client expectations is very important because only a proportion of horses remain sound following PDN as time progresses. Adequate case selection is warranted with either technique and should involve accurate localisation of pain with diagnostic anaesthesia and definitive diagnostic imaging techniques. [ABSTRACT FROM AUTHOR]

Summary: Background: Fissures of the occlusal surface of equine cheek teeth are commonly encountered during oral examination but their aetiology is unknown. Objectives: To examine the prevalence and characteristics of occlusal fissures in cadaver teeth. It is hypothesised that their prevalence is influenced by masticatory forces. Consequently, their possible association with wear disorders and occlusal angles were examined. Study design: Cross‐sectional survey. Methods: The dental abnormalities and occlusal fissure findings in the cheek teeth of 143 cadaver heads were recorded. The cheek teeth occlusal angles were measured using the stiff‐hinge technique. Multiple regression analyses were performed to establish possible relationships between age, sex, dental wear, occlusal angle and fissure prevalence. Results: Occlusal fissures were found in 103/143 (72%) heads. Sex and age were determining factors in the prevalence of fissures. A similar prevalence was found in mandibular (54.1%) and maxillary teeth (45.9%, OR = 1.10; 95% CI = 0.95–1.29, P = 0.2). Mandibular fissures were more commonly located on the buccal aspect (OR = 1.42; 95% CI = 1.16–1.65, P < 0.001), whereas for maxillary fissures there was no difference in prevalence between palatal and buccal aspects (OR = 1.19; 95% CI = 0.97–1.46, P = 0.1). Two main fissure types were identified. Type 1a fissures were the most prevalent type (39.5%). No significant correlation was found between the presence of wear abnormalities or the occlusal angle of cheek teeth, and the prevalence of fissures. Main limitations: No dental histories were available. Conclusion: Equine cheek teeth show a high prevalence of occlusal fissures. Despite some evidence of predilection sites on the tooth surface that might indicate a mechanical aetiology for these lesions, no associations were found with wear abnormalities or occlusal angles of affected cheek teeth. Further histological and ultrastructural studies are warranted to elucidate their aetiology and possible role in other dental diseases. [ABSTRACT FROM AUTHOR]

Reasons for performing study: Controversy exists about the specificity of diagnostic analgesia of the digital flexor tendon sheath (DFTS) in horses. Objectives: To evaluate the degree of diffusion of mepivacaine from the equine DFTS to adjacent synovial structures. Study design: Crossover experiment. Methods: Under general anaesthesia, the DFTS of one front and one hindlimb of 8 horses were injected simultaneously with mepivacaine. Synovial fluid samples of the injected DFTS, the adjacent metacarpo-/metatarsophalangeal (MCP/MTP) joint, proximal interphalangeal joint, distal interphalangeal joint, navicular bursa and contralateral MCP/MTP joint were collected 15 min post injection (T15) from one of the injected limbs and 60 min post injection (T60) from the other limb. Venous blood samples were obtained at T0, T15 and T60 to evaluate systemic distribution of mepivacaine. After a 2-week washout period, the procedure was repeated using the same limbs but reversing the time of sampling (front vs. hindlimbs). The concentration of mepivacaine in samples was measured with a commercial ELISA kit. Results: Mepivacaine concentrations in the DFTS samples, at both T15 (5077 mg/l) and T60 (3503 mg/l), exceeded those estimated sufficient to produce synovial analgesia (100 mg/l or 300 mg/l). Mepivacaine was found in all synovial structures adjacent to the injected DFTS and in the contralateral MCP/MTP joints, but concentrations were low, with a maximum value of only 3.2 mg/l. With the exception of the navicular bursa samples, the mepivacaine concentrations in the adjacent synovial structures were significantly higher at T60 than at T15 (P<0.03). Significantly higher mepivacaine concentrations were found in the ipsilateral than the contralateral MCP/MTP joints at T60 (P<0.001). Blood samples had significantly higher mepivacaine concentrations at T15 and T60 than at T0 (P<0.001). Conclusions: Mepivacaine injected into the DFTS of horses diffuses towards adjacent synovial structures without achieving clinically relevant concentrations. [ABSTRACT FROM AUTHOR]

In this paper, the authors report the results of a genetic-diagnostic survey of 262 instutionalized moderately mentally retarded patients and compare these data with their previous studies of the severely mentally retarded. Special attention is given towards the nosology of X-linked mental retardation and familial mental retardation in general. [ABSTRACT FROM AUTHOR]

A response by P. Van Lancker and colleagues to a letter to the editor regarding their article "Ideal versus corrected body weight for dosage of sugammadex in morbidly obese patients" in the 2011 issue is presented.

The article presents an abstract related to foot problems in caged Asian elephants.

This study evaluated content validity, internal consistency and construct validity of the Strain of Care for Delirium Index (SCDI), a newly constructed instrument to measure the strain nurses experience in caring for patients with delirium. Content validity, evaluated by eight experts, reduced the initial pool of items from 38 to 28. Using a convenience sample of 190 nurses, Cronbach's [Formula: see text] for the 28-item version was 0.88. Using non-linear principal components analysis another eight items were eliminated and a four-factor structure was identified. The proportion of variance explained by the remaining 20 items was 61.51%. Preliminary psychometric evaluation of the SCDI supported content validity, internal consistency and construct validity; however additional psychometric evaluation is warranted. [ABSTRACT FROM AUTHOR]

Early detection of melanoma is a major determinant in disease outcome and drives the number of (over)excised nevi in clinical practice. This study aimed to evaluate demographic features and melanoma risk of clinically suspicious, mainly flat nevus subtypes. Based on the methodology of ex vivo dermoscopy and derm dotting, the 12 most prevalent nevus subtypes were identified in a collection of over 7000 nevi excised for medical reasons. Dermoscopical, histopathological and clinical features of these subtypes were described. In addition, the association with melanoma history, histopathological atypia and melanoma occurrence within nevi was compared. Nearly half of the nevi removed for medical reasons were of the hypermelanotic subtype with no or mild histopathological atypia and low melanoma association, suggesting overtreatment in daily practice. Contrarily, the subtypes atypical lentiginous nevus and orange pulverocytic flat nevus were associated with higher proportions of (severe) atypia and melanoma (history). We believe these subtypes may reflect different tumoral and/or (germline) genetic entities with different melanoma risk. The data from this study may direct further prospective research on specific nevus subtypes in order to obtain better insights in associated clinical/genetic factors and melanoma risk., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Potential synovial penetration following palmar digital nerve blocks has not been investigated., Objectives: To evaluate the proximity of needles placed for palmar digital nerve blocks to nearby synovial structures using computed tomography (CT)., Study Design: Descriptive observational study., Methods: In 18 cadaver forelimbs, sequential injection of the navicular bursa (NB), distal interphalangeal joint (DIPJ) and digital flexor tendon sheath (DFTS) was performed using 3, 5 and 10 mL diluted radiodense contrast medium, respectively. After each synovial injection, 25 gage needles were placed over the palmar digital nerves at the proximal aspect of the ungular cartilages (distal injections) and 1 cm further proximally (proximal injections), and CT examination was performed. Subsequently, needles were removed, and the synovial structures further distended with the same volume as for the first injection. Perineural needle placement and image acquisition were repeated. The distance between the needle tip and adjacent synovial structures was measured (mm) in reconstructed images. Results were analyzed in separate general linear mixed models, to determine the effect of needle position and synovial distension on the distance from the tip of the needle to the NB, DFTS and DIPJ., Results: Synovial penetration was confirmed following 12/420 (3%) needle placements (NB n = 5, 1 after proximal and 4 after distal injections; DIPJ n = 2, DFTS n = 2, NB or DIPJ n = 3, all after distal injections). The mean distance from the needle tip to the NB and DIPJ was significantly smaller after the second distension (NB: p  = 0.025; DIPJ: p  < 0.001) and with the distal needle placements (NB: p < 0.001; DIPJ: p < 0.001). For the DFTS, the distance from the needle tip was significantly smaller with the proximal needle placements ( p  = 0.001)., Main Limitations: Ex-vivo study., Conclusion: There is a small risk of synovial penetration when performing palmar digital nerve blocks, especially when distension of adjacent synovial structures is present., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Gruyaert, Oosterlinck, Haspeslagh and Nagy.)