Browsing by Subject "Ulcer"

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  • Tuomola, Kati; Mäki-Kihniä, Nina; Valros, Anna; Mykkänen, Anna; Kujala-Wirth, Minna (2021)
    Bit-related oral lesions are common and may impair horse welfare. The aim of this study was to investigate the prevalence of oral lesions and their risk factors in a sample of Finnish event horses. The rostral part of the oral cavity (the bit area) of 208 event horses (127 warmbloods, 52 coldbloods, and 29 ponies) was examined in a voluntary inspection after the last competition phase, i.e., the cross-country test. Acute lesions were observed in 52% (109/208) of the horses. The lesion status was graded as no acute lesions for 48% (99/208), mild for 22% (45/208), moderate for 26% (55/208) and severe for 4% (9/208) of the horses. The inner lip commissure was the most common lesion location observed in 39% (81/208) of the horses. A multivariable logistic regression model with data of 174 horses was applied to risk factor analysis. Horses wearing thin (10-13 mm) (OR 3.5, CI 1.4-8.7) or thick (18-22 mm) (OR 3.4, CI 1.4-8.0) bits had a higher risk of moderate/severe lesion status than horses wearing middle-sized (14-17 mm) bits (P = 0.003). Breed was associated with moderate/severe lesion status (P = 0.02). The risk was higher for warmbloods (reference group) and coldbloods (OR 2.0, CI 0.88-4.7) compared with ponies (OR 0.2, CI 0.04-0.87). Mares were at higher risk of moderate/severe lesion status (OR 2.2, CI 1.1-4.5) than geldings (reference group) (P = 0.03). Bar lesions were more common in horses with unjointed bits (40%, 8/20) than with basic double-jointed (10%, 5/52), formed double-jointed (8%, 6/78) or single-jointed bits (5%, 2/40) (Fisher's exact test, P = 0.002). The results of this study suggest that thin and thick bits and mare sex should be considered risk factors for mouth lesions. In addition, in this sample ponies had smaller risk for lesions than other horse breeds. We encourage adopting bit area monitoring as a new routine by horse handlers and as a welfare measure by competition organizers for randomly drawn horses.
  • Hewetson, Michael; Sykes, Ben W; Hallowell, Gayle D; Tulamo, Riitta-Mari (BioMed Central, 2017)
    Abstract Background Equine gastric ulcer syndrome (EGUS) is common in adult horses, particularly those involved in performance disciplines. Currently, detection of EGUS by gastroscopy is the only reliable ante mortem method for definitive diagnosis; however it is unsuitable as a screening test because it is expensive, time consuming, and is not readily available to most veterinarians. Sucrose permeability testing represents a simple, economical alternative to gastroscopy for screening purposes, and the feasibility of this approach in the horse has been previously reported. The aim of this study was to determine the diagnostic accuracy of blood sucrose as a screening test for EGUS in a large group of adult horses with and without naturally occurring gastric disease. Results One hundred and one adult horses with or without naturally occurring gastric ulceration were studied. The diagnostic accuracy of blood sucrose for diagnosis of gastric lesions (GL), glandular lesions (GDL), squamous lesions (SQL), and clinically significant lesions (CSL) at 45 and 90 min after administration of 1 g/kg of sucrose via nasogastric intubation was assessed using receiver operator characteristics (ROC) curves and calculating the area under the curve (AUC). For each lesion type, sucrose concentration in blood was compared to gastroscopy, as the gold standard, and sensitivities (Se) and specificities (Sp) were calculated across a range of sucrose concentrations. Ulcer grading was performed blindly by one observer; and the results were validated by comparing them with that of two other observers, and calculating the level of agreement. Cut-off values were selected manually to optimize Se. The prevalence of GL, GDL, SQL, and CSL was 83, 70, 53 and 58% respectively. At the selected cut-offs, Se ranged from 51 to 79% and Sp ranged from 43 to 72%, depending upon the lesion type and time of sampling. Conclusions Blood sucrose is neither a sensitive or specific test for detecting EGUS in this population of adult horses with naturally occurring gastric ulceration. Further studies aimed at evaluating the performance characteristics of the test in different study populations are warranted. Given the limitations of endoscopy, due consideration should also be given to alternative methods for comparison of blood sucrose with a gold standard.
  • Hewetson, Michael; Sykes, Ben William; Hallowell, Gayle Davina; Tulamo, Riitta-Mari (2017)
    Background: Equine gastric ulcer syndrome (EGUS) is common in adult horses, particularly those involved in performance disciplines. Currently, detection of EGUS by gastroscopy is the only reliable ante mortem method for definitive diagnosis; however it is unsuitable as a screening test because it is expensive, time consuming, and is not readily available to most veterinarians. Sucrose permeability testing represents a simple, economical alternative to gastroscopy for screening purposes, and the feasibility of this approach in the horse has been previously reported. The aim of this study was to determine the diagnostic accuracy of blood sucrose as a screening test for EGUS in a large group of adult horses with and without naturally occurring gastric disease. Results: One hundred and one adult horses with or without naturally occurring gastric ulceration were studied. The diagnostic accuracy of blood sucrose for diagnosis of gastric lesions (GL), glandular lesions (GDL), squamous lesions (SQL), and clinically significant lesions (CSL) at 45 and 90 min after administration of 1 g/kg of sucrose via nasogastric intubation was assessed using receiver operator characteristics (ROC) curves and calculating the area under the curve (AUC). For each lesion type, sucrose concentration in blood was compared to gastroscopy, as the gold standard, and sensitivities (Se) and specificities (Sp) were calculated across a range of sucrose concentrations. Ulcer grading was performed blindly by one observer; and the results were validated by comparing them with that of two other observers, and calculating the level of agreement. Cut-off values were selected manually to optimize Se. The prevalence of GL, GDL, SQL, and CSL was 83, 70, 53 and 58% respectively. At the selected cut-offs, Se ranged from 51 to 79% and Sp ranged from 43 to 72%, depending upon the lesion type and time of sampling. Conclusions: Blood sucrose is neither a sensitive or specific test for detecting EGUS in this population of adult horses with naturally occurring gastric ulceration. Further studies aimed at evaluating the performance characteristics of the test in different study populations are warranted. Given the limitations of endoscopy, due consideration should also be given to alternative methods for comparison of blood sucrose with a gold standard.
  • Hewetson, Michael; Venner, Monica; Volquardsen, Jan; Sykes, Ben William; Hallowell, Gayle Davina; Vervuert, Ingrid; Fosgate, Geoffrey Theodore; Tulamo, Riitta-Mari (2018)
    Background: Equine gastric ulcer syndrome is an important cause of morbidity in weanling foals. Many foals are asymptomatic, and the development of an inexpensive screening test to ensure an early diagnosis is desirable. The objective of this study was to determine the diagnostic accuracy of blood sucrose for diagnosis of EGUS in weanling foals. Results: 45 foals were studied 7 days before and 14 days after weaning. The diagnostic accuracy of blood sucrose for diagnosis of gastric lesions (GL); glandular lesions (GDL); squamous lesions (SQL) and clinically significant gastric lesions (CSL) at 45 and 90 min after administration of 1 g/kg of sucrose via nasogastric intubation was assessed using ROC curves and calculating the AUC. For each lesion type, sucrose concentration in blood was compared to gastroscopy; and sensitivities (Se) and specificities (Sp) were calculated across a range of sucrose concentrations. Cut- off values were selected manually to optimize Se. Because of concerns over the validity of the gold standard, additional Se, Sp, and lesion prevalence data were subsequently estimated and compared using Bayesian latent class analysis. Using the frequentist approach, the prevalence of GL; GDL; SQL and CSL before weaning was 21; 9; 7 and 8% respectively; and increased to 98; 59; 97 and 82% respectively after weaning. At the selected cut- off, Se ranged from 84 to 95% and Sp ranged from 47 to 71%, depending upon the lesion type and time of sampling. In comparison, estimates of Se and Sp were consistently higher when using a Bayesian approach, with Se ranging from 81 to 97%; and Sp ranging from 77 to 97%, depending upon the lesion type and time of sampling. Conclusions: Blood sucrose is a sensitive test for detecting EGUS in weanling foals. Due to its poor specificity, it is not expected that the sucrose blood test will replace gastroscopy, however it may represent a clinically useful screening test to identify foals that may benefit from gastroscopy. Bayesian latent class analysis represents an alternative method to evaluate the diagnostic accuracy of the blood sucrose test in an attempt to avoid bias associated with the assumption that gastroscopy is a perfect test.
  • Hewetson, Michael; Venner, Monica; Volquardsen, Jan; Sykes, Ben W; Hallowell, Gayle D; Vervuert, Ingrid; Fosgate, Geoffrey T; Tulamo, Riitta-Mari (BioMed Central, 2018)
    Abstract Background Equine gastric ulcer syndrome is an important cause of morbidity in weanling foals. Many foals are asymptomatic, and the development of an inexpensive screening test to ensure an early diagnosis is desirable. The objective of this study was to determine the diagnostic accuracy of blood sucrose for diagnosis of EGUS in weanling foals. Results 45 foals were studied 7 days before and 14 days after weaning. The diagnostic accuracy of blood sucrose for diagnosis of gastric lesions (GL); glandular lesions (GDL); squamous lesions (SQL) and clinically significant gastric lesions (CSL) at 45 and 90 min after administration of 1 g/kg of sucrose via nasogastric intubation was assessed using ROC curves and calculating the AUC. For each lesion type, sucrose concentration in blood was compared to gastroscopy; and sensitivities (Se) and specificities (Sp) were calculated across a range of sucrose concentrations. Cut-off values were selected manually to optimize Se. Because of concerns over the validity of the gold standard, additional Se, Sp, and lesion prevalence data were subsequently estimated and compared using Bayesian latent class analysis. Using the frequentist approach, the prevalence of GL; GDL; SQL and CSL before weaning was 21; 9; 7 and 8% respectively; and increased to 98; 59; 97 and 82% respectively after weaning. At the selected cut-off, Se ranged from 84 to 95% and Sp ranged from 47 to 71%, depending upon the lesion type and time of sampling. In comparison, estimates of Se and Sp were consistently higher when using a Bayesian approach, with Se ranging from 81 to 97%; and Sp ranging from 77 to 97%, depending upon the lesion type and time of sampling. Conclusions Blood sucrose is a sensitive test for detecting EGUS in weanling foals. Due to its poor specificity, it is not expected that the sucrose blood test will replace gastroscopy, however it may represent a clinically useful screening test to identify foals that may benefit from gastroscopy. Bayesian latent class analysis represents an alternative method to evaluate the diagnostic accuracy of the blood sucrose test in an attempt to avoid bias associated with the assumption that gastroscopy is a perfect test.
  • Isoherranen, Kirsi; Salmi, Teea; Tasanen, Kaisa (2020)
    Epätyypilliset haavat ovat merkittävä haavatyyppi, johon haavaklinikoiden aineistoissa jopa 10-20 % kroonisista haavoista lukeutuu. Epätyypilliseen haavaan viittaavia tunnusmerkkejä ovat haavan epätyypillinen ulkonäkö tai sijainti, huomattava kipu haavan kokoon nähden, poikkeava hypergranulaatio tai pigmentaatio ja huono hoitovaste. Kliinisen kuvan ja histologisen löydöksen lisäksi diagnosoinnissa tulee huomioida epätyypillisten haavojen liitännäissairaudet. Hoito määräytyy diagnoosin mukaan. Monen epätyypillisen haavaan diagnoosi viivästyy, mikä heikentää potilaan ja haavan paranemisennustetta.
  • Kallio, Milla; Viljamaa, Jaakko; Ranta, Tomi; Ahmajärvi, Kirsti (2020)
    Alaraajaturvotus on kroonisten alaraajahaavojen riskitekijä, ja turvotus estää jo syntyneitä haavoja paranemasta. Kompressiota suositellaan siksi kaikkien alaraajahaavojen hoidoksi, jos raajassa on turvotusta eikä hoidolle ole vasta-aiheita. Jos turvotuksen syytä ei ole mahdollista poistaa, kompressiohoidon tarve on pysyvä. Kompressiohoito jää kuitenkin usein puutteelliseksi tai sitä ei aloiteta lainkaan. Alaraajahaavaa sairastavia potilaita hoitavien on kyettävä tunnistamaan ja ratkaisemaan tavallisimmat kompressiohoitoon liittyvät ongelmat. Tämä onnistuu vain tuntemalla kompressiohoidon ja käytettävien välineiden perusperiaatteet.
  • Ahmajärvi, Kirsti; Isoherranen, Kirsi (2017)
    •Etiologian selvittäminen on kroonisen haavan onnistuneen hoidon edellytys. Mikäli etiologia jää epäselväksi perustutkimusten jälkeen, haavasta tulee ottaa koepala. •Jokaisen haavapotilaan kohdalla on arvioitava hoidon kiireellisyys. •Diabeetikon iskeeminen ja infektoitunut haava sekä akuutti alaraajaiskemia ovat päivystystilanteita. •Jos potilaalla on krooninen iskemiasta johtuva haava, hänet lähetetään kiireellisellä lähetteellä verisuoni¬kirurgian yksikköön. •Neuropaattinen jalkahaava vaatii kevennyshoitoa mahdollisimman nopeasti. •Laskimoperäisen alaraajahaavan tärkein hoito on kompressiohoito. Potilas lähetetään verisuonikirurgin kiireettömällä lähetteellä kajoavan hoidon arvioon, mikäli hän on liikuntakykyinen eikä merkittävän lihava. •Valtaosa painehaavoista on ehkäistävissä. Painehaavan synnyttyä tärkein hoito on ottaa haava-alueelta paine pois. •Hoitosuunnitelma selkeyttää haavapotilaan moniammatillista hoitamista.
  • Hiltunen-Back, Eija; Jeskanen, Leila (2016)
    • Lipschützin haa­vauma on mel­ko harvi­nainen reaktii­vinen vul­van haa­vauma, jo­ka esiintyy nuo­rilla, usein ­sek­suaa­li­sesti koke­mat­to­milla ty­töillä. • Haa­vauman ylei­sim­pänä laukai­se­vana teki­jänä pi­detään mono­nuk­leoosia. • Muu­tos on hyvän­laa­tuinen ja pa­ranee it­sestään. Se tu­lee tun­nistaa ai­nakin pe­diatrin, gyne­ko­login ja derma­to­login vastaa­no­toilla, jot­ta väl­tytään tur­hilta, usein inva­sii­vi­silta tutki­muk­silta ja hoitoy­ri­tyk­siltä se­kä po­tilaan ja van­hempien ahdis­tuk­selta. • Diag­noosi teh­dään yleensä klii­nisen ku­van perus­teella, ja hoi­to on oireen­mu­kainen. • Ky­seessä ei ole seksi­teitse tart­tuva tau­ti.
  • Ruokonen, Hellevi; Matela, Anna-Maija (2016)
  • Isoherranen, Kirsi; Lagus, Heli; Keinonen, Anne; Koskenmies, Sari; Ylitalo, Leea; Övermark, Meri; Pitkänen, Sari (2020)
    • Kroonisen haavan taustalla on pahanlaatuinen kasvain noin 2–4 %:ssa tapauksista. • Kasvaimeen viittaavat haavan epätyypillinen sijainti, epäsäännölliset reunat, voimakas liikakasvu, herkästi vuotava haavan pohja, epätyypillinen pigmentaatio haavan reunalla sekä huono hoitovaste 4–12 viikon kuluessa. • Diagnoosi tehdään koepalasta. • Hoito valikoituu kasvaimen lajin mukaan, mutta ensisijainen hoito on kirurginen.
  • Mönki, J.; Hewetson, M.; Virtala, A.-M. K. (2016)
    BackgroundEquine gastric glandular disease (EGGD) is a term used to classify erosive and ulcerative diseases of the glandular mucosa of the equine stomach. Epidemiologic studies of risk factors for EGGD have not been reported. ObjectiveTo determine risk factors for EGGD. AnimalsCases (n=83) had endoscopic evidence of EGGD; controls (n=34) included healthy horses and horses with equine squamous gastric disease (ESGD) without EGGD. MethodsRetrospective case-control study. The data were analyzed by multivariable logistic regression modeling. Analysis was performed on the full dataset. An additional analysis compared horses with glandular lesions (n=43) against healthy horses (n=22). ResultsOn first analysis, Warmblood breed (OR=13.9, 95% CI 2.2-90.9, P=.005) and an increasing number of caretakers (OR=7.3, 95% CI 0.98-55.6, P=.053) were associated with an increased risk of EGGD. On analysis of the subset of data, Warmblood breed (OR=28.6, 95% CI 2.96-250.0, P=.004) and increasing number of riders (OR=12.99, 95% CI 0.94-166.7, P=.056) were risk factors. The presence of sand in the colon appeared to have a protective effect against EGGD (OR=0.195, 95% CI 0.04-1.0, P=.051 for sand versus not having sand). Conclusions and clinical importanceThis study suggests that Warmbloods are predisposed to EGGD and multiple handlers/riders might increase the risk of EGGD. Identification of risk factors allows speculation on potential pathophysiological mechanisms of EGGD.
  • Kallio, Milla; Lagus, Heli; Isoherranen, Kirsi; Matikainen, Niina (2020)